Alcohol-Related Liver Disease: The Facts about Liver Transplant

Jul 1 10:15am | Kristin Eggebraaten | @keggebraaten

Consuming excessive amounts of alcohol can significantly affect many of your organs, including the health of your liver. Excessive alcohol consumption can contribute to three progressive stages of liver disease: fatty liver disease, alcohol-related hepatitis, and finally cirrhosis. Symptoms of these liver conditions may not show up until your liver is significantly damaged. If you stop drinking, your liver damage could heal, but once scar tissue builds up and replaces most of your healthy liver cells, the condition is not reversible.

If you’ve been diagnosed with alcohol-related liver disease, you must stop drinking alcohol completely and never drink alcohol again. This is the only way to possibly reverse the liver damage and prevent your disease from progressing. Be sure to discuss plans to quit with your doctor.  Plans to “just quit,” often work in the short-term, though not uncommonly result in eventual relapse to drinking.  Patients whose plans include counseling, support groups, treatment programs or medications are generally in the best position to maintain long-term sobriety and to qualify for a liver transplant.

Patients whose liver has been damaged by alcohol consumption that is not reversible can be considered for liver transplant. Transplant can be successful for alcohol-related liver disease if patients follow the recommendations of their care team.

To qualify for liver transplant, patients need to do two things:

  1. Find a liver transplant program that works for you and your insurance coverage.
  2. Meet the requirements of the program, which generally include lifelong commitment to alcohol abstinence, compliance with the program’s treatment recommendations, and completion of a successful medical and psychosocial evaluation for transplant. Programs across the country may have a variety of specific recommendations individualized for each patient.

You may have heard about something called a “6-Month Rule.”  When transplant centers began offering liver transplantation to patients with alcohol-related liver disease many years ago, the goal then, like today, was to help prepare patients for long-term survival after transplant.  It was found that patients with six months or more of sobriety before transplant were more likely to resist relapse after transplant and see more success from their transplanted organ.  So many transplant centers required a 6-month minimum abstinence to qualify for a transplant.  Since then, it has been found that highly motivated patients with shorter sobriety time may do well.

Most transplant centers no longer require a specific length of pre-transplant abstinence.  Therefore, if you or your loved one has alcohol related liver disease, it’s most important for the patient to immediately stop drinking, seek medical attention through a qualified liver specialist, and pursue the recommendations of the transplant program for establishing and maintaining sobriety.

What is true?

  • Transplant centers in the U.S. require patients stop drinking alcohol prior to being placed on the waiting list for liver transplant.
  • Most transplant centers in the U.S. require patients to undergo formal treatment for their alcohol use. The type of treatment varies by patient and their individual situation.
  • Transplant centers in the U.S. require all transplant patients (with all diagnoses) to follow the transplant center’s recommendations and policies regarding transplant prior to being placed (and while ON) the waiting list for any organ transplant.

What is not true?

  • At Mayo Clinic and most U.S. transplant centers, there is NOT an absolute rule of 6 months abstinence to be listed for transplant if you have alcohol-related liver or other organ disease.

Transplant centers, including Mayo Clinic, require most patients to undergo assessment for your alcohol use as soon as possible. Most patients are required to attend a formal treatment program and meetings such as Alcoholics Anonymous. Your doctor will provide you with the treatment options for your specific situation. Patients who are pursuing these recommendations will be seriously considered for liver transplant.

While most people, including those with alcohol problems, can stop drinking for periods of time, longer term sobriety is often very difficult to achieve.  The necessary skills and support system to help ensure long-term abstinence do not develop overnight, and it typically takes several meetings, counseling sessions, and appointments with your doctors for patients to remain abstinent from alcohol.  For your liver transplant to be successful, this process needs to be a lifelong commitment to be free from alcohol and an openness to directly address the problem.

  • Not only do transplant centers want each patient to do very well, but they are also committed to be good stewards of a limited organ supply. Unfortunately, there are NOT enough organs available for every patient in need of a liver transplant.

Because there is not an unlimited supply, transplant centers are tasked with providing organs to patients who will benefit most from the organ transplant. Therefore transplant centers must thoroughly evaluate patients to be sure they are free from all serious conditions that may affect the long-term health of the transplanted liver. Transplant centers take this task very seriously and have systems in place that are as effective and as fair as possible to make the best use of the limited resources of donated organs.

Mayo Clinic is committed to caring for patients in need of a liver transplant. We wish the organ availability was better so we could offer every patient the opportunity for surgery. Our teams are working diligently on ways to increase the donor pool so future patients can benefit from increased numbers of transplants. Every day is a new opportunity to improve, and we take every opportunity to help make patients’ lives better.

Have you been evaluated for liver transplant? What advice would you give to someone just beginning the process?

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