Abstract
Alcohol affects many aspects of organ transplantation whether or not alcohol is the primary cause of organ damage. It exerts complex biological, psychological, and social effects on transplant candidates and recipients across continuums of care and patient lifespan while evoking strong emotion in families, organ donors, transplant teams, and the public. The importance of this issue is growing as alcohol-related problems in society worsen. The transplant field must continue to grapple with how to advocate for patients and equitably allocate donor organs in a population increasingly burdened with the effects of drinking alcohol.
In this chapter, we will use two clinical cases, one pre-transplant and one post-transplant to depict the sweeping complexity of alcohol as it intersects with organ transplantation. Due to the high prevalence of alcohol use disorders in liver disease, both cases are liver transplant patients. Many of the issues discussed in this chapter, however, will extrapolate to other solid organ transplant teams and environments. We also deliberately selected complex cases to depict the scope of challenges and to guide the reader through practical and real-world examples.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
WHO. Global status report on alcohol and health, 2018. World Health Organization; 2018.
Guirguis J, Chhatwal J, Dasarathy J, Rivas J, McMichael D, Nagy LE, et al. Clinical impact of alcohol-related cirrhosis in the next decade: estimates based on current epidemiological trends in the United States. Alcohol Clin Exp Res. 2015;39(11):2085–94.
Mellinger JL, Shedden K, Winder GS, Tapper E, Adams M, Fontana RJ, et al. The high burden of alcoholic cirrhosis in privately insured persons in the United States. Hepatology. 2018;
Pompili M, Serafini G, Innamorati M, Dominici G, Ferracuti S, Kotzalidis GD, et al. Suicidal behavior and alcohol abuse. Int J Environ Res Public Health. 2010;7(4):1392–431.
Grant BF, Stinson FS, Dawson DA, Chou SP, Dufour MC, Compton W, et al. Prevalence and co-occurrence of substance use disorders and independentmood and anxiety disorders: results from the national epidemiologic survey on alcohol and relatedconditions. Arch Gen Psychiatry. 2004;61(8):807–16.
Cholankeril G, Ahmed A. Alcoholic liver disease replaces hepatitis C virus infection as the leading indication for liver transplantation in the United States. Clin Gastroenterol Hepatol. 2018;16(8):1356–8.
Mellinger JL, Winder GS, DeJonckheere M, Fontana RJ, Volk ML, Lok AS, et al. Misconceptions, preferences and barriers to alcohol use disorder treatment in alcohol-related cirrhosis. J Subst Abus Treat. 2018;91:20–7.
Mccallum S, Masterton G. Liver transplantation for alcoholic liver disease: a systematic review of psychosocial selection criteria. Alcohol Alcohol. 2006;41(4):358–63.
Dew MA, DiMartini AF, Steel J, De Vito DA, Myaskovsky L, Unruh M, et al. Meta-analysis of risk for relapse to substance use after transplantation of the liver or other solid organs. Liver Transpl. 2008;14(2):159–72.
De Gottardi A, Spahr L, Gelez P, Morard I, Mentha G, Guillaud O, et al. A simple score for predicting alcohol relapse after liver transplantation: results from 387 patients over 15 years. Arch Intern Med. 2007;167(11):1183–8.
Pfitzmann R, Schwenzer J, Rayes N, Seehofer D, Neuhaus R, Nüssler NC. Long-term survival and predictors of relapse after orthotopic liver transplantation for alcoholic liver disease. Liver Transpl. 2007;13(2):197–205.
DiMartini A, Day N, Dew MA, Javed L, Fitzgerald MG, Jain A, et al. Alcohol consumption patterns and predictors of use following liver transplantation for alcoholic liver disease. Liver Transpl. 2006;12(5):813–20.
Asrani SK, Trotter J, Lake J, Ahmed A, Bonagura A, Cameron A, et al. Meeting report: the Dallas consensus conference on liver transplantation for alcohol associated hepatitis. Liver Transpl. 2020;26(1):127–40.
Winder GS, Fernandez A, Klevering K, Mellinger JL. Confronting the crisis of comorbid alcohol use disorder and alcohol-related liver disease with a novel multidisciplinary clinic. Psychosomatics. 2019;
Bohn MJ, Babor TF, Kranzler HR. The alcohol use disorders identification test (AUDIT): validation of a screening instrument for use in medical settings. J Stud Alcohol. 1995;56(4):423–32.
Maldonado JR, Dubois HC, David EE, Sher Y, Lolak S, Dyal J, et al. The Stanford integrated psychosocial assessment for transplantation (SIPAT): a new tool for the psychosocial evaluation of pre-transplant candidates. Psychosomatics. 2012;53(2):123–32.
Fleming MF, Smith MJ, Oslakovic E, Lucey MR, Vue JX, Al-Saden P, et al. Phosphatidylethanol detects moderate-to-heavy alcohol use in liver transplant recipients. Alcohol Clin Exp Res. 2017;41(4):857–62.
Wurst FM, Skipper GE, Weinmann W. Ethyl glucuronide—the direct ethanol metabolite on the threshold from science to routine use. Addiction. 2003;98(s2):51–61.
Gittell JH. High performance healthcare: using the power of relationships to achieve quality, In: Efficiency and resilience: McGraw Hill Professional; 2009.
DiMartini A, Dew MA, Day N, Fitzgerald MG, Jones BL, DeVera M, et al. Trajectories of alcohol consumption following liver transplantation. Am J Transplant. 2010;10(10):2305–12.
Dumortier J, Dharancy S, Cannesson A, Lassailly G, Rolland B, Pruvot F-R, et al. Recurrent alcoholic cirrhosis in severe alcoholic relapse after liver transplantation: a frequent and serious complication. Am J Gastroenterol. 2015;110(8):1160–6.
Björnsson E, Nordlinder H, Olsson R. Clinical characteristics and prognostic markers in disulfiram-induced liver injury. J hepatol. 2006;44(4):791–7.
Bertolotti M, Ferrari A, Vitale G, Stefani M, Trenti T, Loria P, et al. Effect of liver cirrhosis on the systemic availability of naltrexone in humans. J hepatol. 1997;27(3):505–11.
Guglielmo R, Martinotti G, Quatrale M, Ioime L, Kadilli I, Di Nicola M, et al. Topiramate in alcohol use disorders: review and update. CNS Drugs. 2015;29(5):383–95.
Mason BJ, Quello S, Shadan F. Gabapentin for the treatment of alcohol use disorder. Expert Opin Investig Drugs. 2018;27(1):113–24.
Addolorato G, Leggio L, Ferrulli A, Cardone S, Vonghia L, Mirijello A, et al. Effectiveness and safety of baclofen for maintenance of alcohol abstinence in alcohol-dependent patients with liver cirrhosis: randomised, double-blind controlled study. Lancet. 2007;370(9603):1915–22.
Luchsinger W, Zimbrean P. Systematic review: treatment for addictive disorder in transplant patients. Am J Addict. 2020;29(6):445–62.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2022 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Winder, G.S., Fernandez, A.C., Clifton, E.G., Mellinger, J.L. (2022). Alcohol Use Disorders in Organ Transplantation. In: Zimbrean, P.C., Sher, Y., Crone, C., DiMartini, A.F. (eds) Transplant Psychiatry. Springer, Cham. https://doi.org/10.1007/978-3-031-15052-4_17
Download citation
DOI: https://doi.org/10.1007/978-3-031-15052-4_17
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-031-15051-7
Online ISBN: 978-3-031-15052-4
eBook Packages: MedicineMedicine (R0)