Purpose: Given the scarcity of resources, questions arose on the most valuable indications for liver transplantation (LT). In France, the number of patients with alcoholic cirrhosis registered on the National Waiting List (NWL) is lower than that of others. Alcoholic cirrhosis has been identified as an indication of LT as well as cirrhoses of other origins given certain conditions. Patients with alcoholic liver disease when transplanted had been found to have similar or better outcomes than those with other liver diseases. The aim of this study was to determine among characteristics of inpatients, hospital physician opinion and settings, the factors associated with the patient being considered as a potential candidate to LT.
Method: An observational study of the consecutive inpatients with liver cirrhosis of whatever origin included in a multi-centre cohort constituted in mostly non teaching hospital from February 2003 to May 2008 using structured questionnaires. “Completely” or “rather completely” potential candidates for LT in the opinion of the caring physician were defined as potential candidates to LT. Patients were considered as alcoholic when the consumption was more than 30g/j for a man and of 20g/j for a woman.
Result: Four hundred and three inpatients were included. Their average age was 58.2 years (standard deviation: 10.9), 71.0% were men, 85.0% had alcoholic cirrhosis, 39.5% a Child-Pugh score class C and 21.0% were considered as potential candidates to LT. There were no significant differences between potential candidates and the others according to sex, duration of alcohol consumption, and between alcoholic and non alcoholic patients. The factors independently associated with being a potential candidate for LT were: physician empathy (Odds Ratio [OR] = 12.0; 95% CI: 4.1-35.2), treatment observance (OR = 8.4; 95% CI: 1.7-40.2), Languedoc-Roussillon area (OR=7.4 ; 95% CI: 2.0-29.3), Child-Pugh score class B (OR = 2.7; 95% CI:1.1-6.6), non or low frequency alcohol consumption (OR = 2.4; 95% CI: 1.1-5.3) and patient age (OR = 2.4; 95% CI: 1.1-5.0).
Conclusion: Alcoholism does not directly appear to limit potential candidatures to NWL registration. The caring physician’s opinion on the patient and of his or her involvement in managing his or her illness seem to be prominent.
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