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

Journal article
Authors Andreas Schult
K. Stokkeland
B. G. Ericzon
R. Hultcrantz
J. Franck
P. Stal
Maria Castedal
Published in Scandinavian Journal of Gastroenterology
Volume 54
Issue 9
Pages 1146-1154
ISSN 0036-5521
Publication year 2019
Published at Institute of Medicine, Department of Molecular and Clinical Medicine
Institute of Clinical Sciences
Pages 1146-1154
Language en
Keywords Alcoholic liver cirrhosis, addiction severity index, lifetime drinking history, non-alcoholic liver, addiction severity index, lifetime drinking history, long-term survival, substance use, relapse, consumption, reliability, predictors, validity, patterns, Gastroenterology & Hepatology
Subject categories Gastroenterology and Hepatology


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.

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