Facing life-or-death call on who gets liver transplants - Harvard Gazette

"The stakes are high. Patients with decompensated liver disease, or what commonly has been referred to as end-stage liver disease, have drastically shortened life expectancies without transplantation. In one study, patients in this stage who developed complications lived only two years after diagnosis. But a transplant is not always a final solution. As many as 20 percent of all patients with a history of alcohol use disorder will relapse after surgery."

""If we know a patient is going to relapse after liver transplant, the evidence is that the chance of them developing recurrent cirrhosis in three years is about 50 percent and the chance of dying from the recurrent liver disease in five years is about 50 percent," Zhang said. "We do a lot of interventions to prevent them from going back to drinking"

Surgeons must weigh scarce donor livers against patient survival probabilities, especially when alcohol-use disorder is present. Evaluations combine medical status, support networks, personal history, and knowledge of alcohol-use disorder's link to liver disease. Patients with decompensated liver disease face drastically reduced life expectancy without transplantation, with some studies showing two-year survival after complications. Transplant does not guarantee cure: roughly 20 percent of patients with prior alcohol-use disorder relapse after surgery. Relapse dramatically raises the risk of recurrent cirrhosis and death within three to five years, prompting extensive interventions to prevent postoperative drinking.

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