Return to Drinking After Liver Transplantation for Alcoholic Liver Disease

Patients with a liver transplant for alcoholic liver disease are advised to abstain permanently from alcohol. To measure the recurrence of alcohol use after liver transplantation, researchers assessed 167 liver recipients every 3 months during the first year after the transplant and then every 6 months for 4 years thereafter. At routine appointments, patients received recommendations for complete abstinence from alcohol and additional counseling if they had returned to drinking. The majority of patients had alcohol dependence (alcoholism), and were sober for an average of 40 months before transplantation.

During the first year after transplantation, 22% of subjects had at least 1 drink. Ten percent had at least 1 heavy drinking episode (6 drinks a day for men and 4 drinks a day for women). And 5% returned to frequent drinking (4 drinking days per week).

By the fifth year after the transplant, 42% had at least 1 drink, 26% had at least 1 heavy drinking episode, and 20% returned to frequent drinking.

Longer sobriety before the transplant delayed the time to first drink and heavy drinking.

Alcoholism and depression predicted significantly higher alcohol use after the transplant.

Conclusion: This study shows that although the majority of liver recipients do not drink heavily, a substantial proportion returns to some alcohol use after transplantation for alcoholic liver disease. The findings highlight the need for supportive strategies, particularly those that increase the length of sobriety before the transplant, to minimize alcohol use after the transplant.

Therapy should include attendance at Alcoholics Anonymous for alcoholism which is known to increase alcohol abstinence.