LIVER TRANSPLANTATION FOR ALCOHOLIC LIVER DISEASE: A SYSTEMATIC REVIEW OF PSYCHOSOCIAL SELECTION CRITERIA

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Abstract
Aims: To examine the evidence base for psychosocial selection criteria for liver transplant candidates with alcoholic liver disease. Method: Systematic review using three electronic databases supplemented by hand searches. Results: Out of 96 published studies, 22 were included. All but one were cohort design, most were retrospective, single centre, and small sample. Methodology varied considerably, such that meta-analysis was not feasible. Conclusions: Social stability, no close relatives with an alcohol problem, older age, no repeated alcohol-treatment failures, good compliance with medical care, no current polydrug misuse, and no co-existing severe mental disorder have all been associated with future abstinence in more studies than not, in those that examined these variables. Duration of preoperative abstinence was a poor predictor. We recommend that, if predicting future abstinence is considered necessary by transplant teams, a standardized approach is agreed and deployed amongst transplant units, then audited and reviewed.