Louisville Medicine Volume 67, Issue 5 | Page 24

THE COMPLEXITY OF ALCOHOL (continued from page 21) disease was due to a patient’s voluntary actions—and, accordingly, providing a deceased donor LT to patients with ALD means taking a scarce resource away from patients who are purportedly “more deserving.” As one ethicist posits, “what justifies giving them low- er priority for a liver transplant is that they are not only causally but also morally responsible for their liver failure.” 19 10. 11. 12. CONCLUSION At this time, liver transplant remains the only durable long-term therapy for ALD. Appropriate patients with end-stage liver dis- ease secondary to alcoholic cirrhosis should be considered for liver transplantation, just as other patients with decompensated liver disease, after careful evaluation of medical and psychosocial candidacy. In addition, this evaluation should include a formal as- sessment of the likelihood of long-term abstinence. Patient selec- tion criteria is center dependent with most requiring six months of sobriety. Return to harmful drinking after transplant remains a unique challenge in this population and ethical issues surround- ing liver transplant for ALD remain contentious. At the Trager Transplant Center, we believe equity in access to transplantation is an ethical requirement. Treating all liver patients the same way eliminates the possibility that some patients gain quicker access to transplantation than others because of a trait, such as demograph- ics, experiences or behaviors. Dr. Jones is the division director of the University of Louisville’s Department of Surgery, Division of Transplantation. Dr. Adamson is a practicing surgeon in UofL’s Department of Surgery, Division of Transplantation. (non-member) References 1. Patrick CH. Alcohol, Culture, and Society. Durham, NC: Duke Univer- sity Press; 1952. 2. 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 Aug;16(8):1356- 1358. 3. Mandayam S, Jamal MM, Morgan TR. Epidemiology of alcoholic liver disease. Semin Liver Dis 2004;24:217-232. 4. Welte J, Barnes G, Wieczorek W, Tidwell MC, Parker J. Alcohol and gambling pathology among U.S. adults: prevalence, demographic pat- terns and comorbidity. J Stud Alcohol 2001;62:706-712. 5. Caetano R, Tam T, Greenfield T, Cherpitel C, Midanik L. DSM-IV al- cohol dependence and drinking in the U.S. population: a risk analysis. Ann Epidemiol 1997;7:542-549. 6. Tam TW, Midanik LT. The effect of screening on prevalence esti- mates of alcohol dependence and social consequences. J Stud Alcohol 2000;61: 617-621. 7. Greenfield TK, Midanik LT, Rogers JD. A 10-year national trend study of alcohol consumption, 1984-1995: is the period of declining drinking over? Am J Public Health 2000;90:47-52. 8. Hasin D, Paykin A, Meydan J, Grant B. Withdrawal and tolerance: prognostic significance in DSM-IV alcohol dependence. J Stud Alcohol 2000;61:431-438. 9. American Psychiatric Association. Diagnostic and Statistical Manual 22 LOUISVILLE MEDICINE 13. 14. 15. 16. 17. 18. 19. of Mental Disorders, ed. 4. Washington, DC: American Psychiatric As- sociation; 1994. Chick J, Erickson CK. Conference summary: Consensus Conference on Alcohol Dependence and the Role of Pharmacotherapy in its Treat- ment. Alcohol Clin Exp Res 1996;20:391-402. Kitchens JM. Does this patient have an alcohol problem? JAMA 1994; 272:1782-1787. Corrao G, Ferrari P, Zambon A, Torchio P. Are the recent trends in liver cirrhosis mortality affected by the changes in alcohol consump- tion? Analysis of latency period in European countries. J Stud Alcohol 1997;58: 486-494. Starzl TE, Van Thiel D, Tzakis AG, Iwatsuki S, Todo S, Marsh JW, Kone- ru B, Staschak S, Stieber A, Gordon RD. Orthotopic liver transplanta- tion for alcoholic cirrhosis. JAMA. 1988 Nov 4;260(17):2542-4. Veldt BJ, Laine F, Guillygomarc’h A, Lauvin L, Boudjema K, Mess- ner M, et al. Indication of liver transplantation in severe alcoholic liver cirrhosis: quantitative evaluation and optimal timing. J Hepatol 2002;36:93-98. Burra P, Senzolo M, Adam R, Delvart V, Karam V, Germani G, Neu- berger J. Liver transplantation for alcoholic liver disease in Europe: a study from the ELTR (European Liver Transplant Registry). Am J Transplant. 2010 Jan;10(1):138-48. Tome S, Lucey MR. Timing of liver transplantation in alcoholic cirrho- sis. J Hepatol. 2003 Sep;39(3):302-7. DiMartini A, Dew MA, Day N, Fitzgerald MG, Jones BL, deVera ME, Fontes P. Trajectories of alcohol consumption following liver transplan- tation. Am J Transplant. 2010 Oct;10(10):2305-12. Dumortier J, Dharancy S, Cannesson A, Lassailly G, Rolland B, Pruvot FR, Boillot O, Faure S, Guillaud O, Rigole-Donnadieu H, Herrero A, Scoazec JY, Mathurin P, Pageaux GP. Recurrent alcoholic cirrhosis in severe alcoholic relapse after liver transplantation: a frequent and seri- ous complication. Am J Gastroenterol. 2015 Aug;110(8):1160-6. Glannon W. Responsibility and priority in liver transplantation.In: Bay- liss F, Borgerson K, Hoffmaster B, Sherwin S, eds. Health Care Ethics in Canada. 3rd ed. Toronto, ON: Nelson Education; 2012:122.