DO PHYSICIANS OF PRIMARY CARE HOSPITALS LIMIT THE ACCESS OF ALCOHOLIC PATIENTS TO LIVER TRANSPLANTATION (LT)?

Purposes: To study in French primary care hospitals the characteristics of patients admitted for a complication of alcoholic cirrhosis and the opinion of physicians on their aptitude to be transplanted.

Methods: Prospective analysis of the consecutive patients hospitalized in 9 hospitals during 4 years for a complication of a cirrhosis, using structured questionnaires for each patient and each attending physician. Cirrhosis was considered due to alcoholism if associated with excessive alcohol consumption (WHO criteria), and if other causes had been excluded.

Results: Among 331 patients, 73% were men, median age was 55 yrs (28-82). At admission, 56.5% were classified Child-Pugh C, 56.9% had non complicated, 8.2 % infected and 14.1% refractory ascite, 28.0% digestive bleeding, 7.2% hepatorenal syndrome, 21.1% encephalopathy, 12.6% hepatocellular carcinoma. All of them were potential candidates to LT. Only 54.8 % acknowledged significant alcohol consumption, but 89.6 % declared having had previous periods of heavy alcoholism.  

Alcohol consumption according to	Attending physicians
	Moderate	Excessive	p
Patients
0-100 g/week	15.2%	10.1%	< 0.0001
110-400 g/week	81.3%	68.9%
> 410 g/week	3.5%	20.9%
Compliance to follow-up	92.2%	85.6%	0.101
Alcohol-dependence	49.7%	43.9%	0.334
Potential candidate to LT	52.1%	19.4%	< 0.0001

Current alcohol consumption was estimated differently by physicians and patients (kappa coefficient 48.5 %). The level of alcohol intake had no significant effect on compliance to follow-up (i.e, omission of visits), and was not related to alcohol dependence (i.e., answers to the CAGE questionnaire). Only 36.9% were considered adequate candidates to LT vs. 56.5% of non-alcoholic cirrhotic patients admitted during the same period. This rate was only 19.4% in patients with alcohol excessive consumption. Alcoholism (49.5% of cases), mainly lack of abstinence, was the main cause leading to exclusion from LT.

Conclusion: The rate of patients considered for LT is lower in alcoholics than in non-alcoholics. Physicians may limit access at the level of primary care hospitals.