Negative outcomes after liver transplantation in patients with alcoholic liver disease beyond the fifth post-transplant year

Although up to 50% of patients with alcoholic liver disease (ALD) resume alcohol consumption after liver transplantation (LT), numerous studies indicate that long-term results are not compromised. This study focused on evaluating the impact of ALD on outcomes up to and beyond the fifth year after LT. Among the 432 primary LT recipients included in this study, 97 underwent transplantation for ALD. Alcohol relapse rate at 10yr was 33.5%, with younger recipient age being the only independent predictor (p=0.019). Survival of patients with ALD (77.0%) was similar to those without (79.0%) up to the fifth post-transplant year (p=0.655) but worse during the five subsequent years among the five-yr survivors (70.6% vs. 92.9%; p=0.002). ALD was an independent risk factor for poorer survival beyond the fifth post-transplant year (p=0.049), but not earlier (p=0.717). Conversely, alcohol relapse increased the risk of death only during the first five post-transplant years (p=0.039). There were no significant differences regarding graft failure incidence between ALD and non-ALD recipients up to the fifth post-transplant year (7.3% vs. 11.6%; p=0.255) and beyond (12.9% vs. 5.0%; p=0.126). In conclusion, pre-transplant diagnosis of ALD yields negative effects on post-transplant outcomes beyond the fifth post-transplant year, not attributable to recidivism.