Alcohol and drug use prior to liver transplantation: more common than expected in patients with non-alcoholic liver disease

Abstract

Objective: Liver transplantation (LT) is a life-saving procedure for patients with end-stage liver disease, acute liver failure or hepatocellular carcinoma (HCC). Patients with known alcoholic liver cirrhosis (ALC) are usually assessed by an addiction specialist, but patients with other liver diseases may also exhibit harmful drinking. This study aims to assess the drinking habits in LT-recipients with or without a diagnosis of ALC.

Patients and methods: Between April 2012 and December 2015, 190 LT-recipients were interviewed using the Lifetime Drinking History (LDH) and the Addiction Severity Index (ASI). Patients were categorized according to their diagnoses: ALC (group A, n = 39), HCC or hepatitis C (group B, n = 56) or other liver diseases (group C, n = 95). Data were analysed using descriptive statistic methods.

Results: Fifteen of 95 patients (15.8%) in group C – a cohort without suspected addiction problems – had either alcohol consumption or binge drinking within the upper quartile of the overall cohort. The aetiology of liver disease in this subgroup included mainly cholestatic and cryptogenic liver disease. Illicit drugs had been used by 35% of all patients. Cannabis and amphetamine were the most common drugs and had the longest duration of regular use.

Conclusions: LT candidates without known alcohol or drug use may have a clinically significant consumption of alcohol and previous illicit drug use. Efforts should be put on identification of these patients during LT evaluation. The use of structured questionnaires such as the ASI and the LDH could facilitate detection of alcohol and drug problems.

Keywords:

• Alcoholic liver cirrhosis
• addiction severity index
• lifetime drinking history
• non-alcoholic liver cirrhosis
• substance use

Acknowledgements

The authors thank the patients for their kindness to participate in the time-consuming interviews, often directly after transplant surgery. We also want to thank the research staff at Karolinska and Sahlgrenska University Hospitals (Micaela Viss, Rebecka Broman, Bianca Billing-Werner, Camilla Palmgren, Cickie Holmén, Marita Rosenberg, Ingela Broman and Christina Wibeck) for their commitment in interviewing and documenting the results of this large cohort of patients. We are grateful to Espen Melum at Scandiatransplant for providing data from the Nordic Liver Transplant Registry (NLTR).

Disclosure statement

The authors declare that they have no conflict of interest.

Author’s contributions

AS organized the data, did the statistical analysis and wrote and revised the main manuscript. KS designed the study, collected data, wrote and revised the manuscript. BGE revised the manuscript. RH designed the study and revised the manuscript. JF was responsible for the study interviews and revised the manuscript. PS designed the study and revised the manuscript. MC designed the study, wrote and revised the manuscript, presented the study development at frequent Nordic Liver Transplant Group meetings (NLTG).

Additional information

Funding

This study was supported by research grants from The Rolf Olsson Stipendium and The Swedish Council for Information on Alcohol and Other Drugs (CAN).