Doc: Alcohol-induced cirrhosis eligible for transplant
Dear Dr. Roach: My 52-year-old sister was diagnosed with cirrhosis of the liver due to alcohol. She has significant financial resources and gold-standard health care. Her liver has failed to bounce back. This month, she was placed on a liver-transplant list. How long can my sister live with alcoholic liver cirrhosis while awaiting a liver transplant? If she complies with transplant protocol (no alcohol, no salt, counseling, etc.), how likely is it that any alcoholic receives a liver donation? The doctors say her MELD score is 25. Could her liver recover so that she won’t need a transplant?
Dear S.H.: I am sorry to hear about your sister. Prolonged, heavy alcohol use can lead to cirrhosis, which is an irreversible condition of liver damage. Stopping alcohol use usually prevents progression of liver disease. Liver disease is estimated by the MELD score. Less than 15 is mild; greater than 35 is the most severe. It is unlikely that her liver would recover with this degree of damage.
According to the most up-to-date statistics from the U.S. Organ Procurement and Transplantation Network, there are 14,000 people waiting for a liver transplant now. People with more severe liver disease are higher priority for the very limited number of organs that become available. As of December 2016, the median wait time for a liver transplant for a person with a MELD score between 15 and 34 was about eight months, meaning that half of people on the waiting list will be transplanted within eight months, and the other half will still be waiting. About 10 percent of people between ages 50 and 64 die each year waiting for a transplant.
People with acute liver failure, from whatever cause, are more likely to die awaiting transplant than people who are on the transplant list for other causes, including alcoholic liver disease, hepatitis C or other causes. The vast majority of deaths on the waiting list are in people whose MELD score is above 35, which is why they are at such high priority for an organ.
It used to be the case that people with alcoholic liver disease were considered lower priority for transplant. However, the data show that liver transplantation is just as effective in selected patients with alcoholic liver disease as any other cause. However, abstinence from alcohol is an expectation for people on the transplant list. Many centers use a six-month rule prior to listing a patient; however, the six-month rule is somewhat arbitrary, and the earlier a person is listed, the better the likelihood of getting an organ. In studies, between 11 percent and 30 percent of people will drink after transplant, but only 5 percent had “excessive” drinking.
Email questions to ToYourGoodHealth@med.cornell.edu.