Alcohol consumption, alcohol use disorder and organ transplantation.

BACKGROUND

In the present experience we have evaluated the link alcohol consumption/alcohol use disorder (AUD) and organ transplantation (OT) in order to provide adequate suggestions.

METHODS

The data used for the preparation of these recommendations are based on a detailed analysis of the scientific literature published before August 31, 2022 (Web of Science, Scopus, Google Scholar). Furthermore, in the process of developing this work, we consulted the guidelines / position papers of the scientific societies.

RESULTS

With regard to the liver transplantation, there are position papers/ guidelines that clearly define indications and contraindications for including the AUD patient in the transplant list. One of the major difficulties in this area is psychosocial assessment which can be influenced by stigma. To solve this problem it is necessary to use objective tools. However, this assessment should be carried out after providing the patient and family adequate tools to be able to create or recreate reliable socio-family support. This behavior should also be used in the case of other OTs. For the latter, however, adequate guidelines must be created which at the moment do not exist or if there are, as in the case of heart transplantation, they are not sufficient.

CONCLUSIONS

1) Even in the absence of obvious alcohol addiction, use alcohol use disorder identification test. 2) Include the addiction specialist in the multidisciplinary transplant team. 3) Provide family members with the tools necessary to better support the patient. They are patients with alcohol use disorder/ possible presence of psychopathological manifestations and alcohol-related pathology (cirrhosis, cardiomyopathy, liver-kidney disfunction, etc). 4) Cardiovascular and oncologic surveillance post-OT. 5) For the selection of patients to be included in the list for non-LT (heart, lung, kidney, multivisceral, etc) it is mandatory to include the diagnosis and treatment of AUDs in the guidelines. What has already been indicated for LT may be useful. Timing of alcoholic abstention in relation to clinical severity, optimal psychosocial activity, anti-craving therapy in relation to the type of underlying disease and clinical severity. 9) Close collaboration between scientific societies is required to better manage AUD patients who need OT.