Dr. Joe Galati's Blog

New Hepatitis C Therapies Are Closer Than Ever

Telaprevir, Boceprevir Improve HCV Cure Rates. The new therapies for chronic hepatitis C are closer than ever. While we have been participating in conducting may of these trials, it has never been more exciting for both patients and physicians who care for hepatitis C patients. Here is an anaylsis from the recent AASLD meeting in Boston this month. Read more here.

Alcohol Use While Awaiting Liver Transplant

This issue has always been a hot button subject for those of us in transplant. First, we would like our patients to be compliant with our program, and abstain from alcohol. Secondly, there is a poor public image of the patient awaiting liver transplant, who also is using alcohol as they wait for a new liver. These perceptions from the general public have the potential to reduce the opportunities for organ donation, fearing their loved ones organs are go to "an alcoholic who will squander their opportunity to survive with my loved ones liver."

The article listed below from a recent issue of Liver Transplantation does a good job of explaining their experience with alcohol pre-transplant.

Alcoholic liver disease (ALD) is a leading indication for liver transplantation. Our center has randomly checked blood alcohol levels (BALs) in ALD patients on the waiting list since 2004. We aimed to identify the incidence and predictors of inactivation on the transplant list due to alcohol use and to determine the utility of BAL-screening in this process. We conducted a retrospective review of patients with ALD listed for liver transplantation with at least 3 months of postlisting follow-up. Alcohol use while on the transplant list was defined as a positive BAL, an admission of alcohol use, or refusal to perform screening within 12 hours of request. Cox proportional hazards regression was used to estimate risk ratios (RRs). Of 134 patients meeting eligibility criteria, 78% were male, and mean age was 52 years. Alcohol use was documented in 23 patients (17%). Of these, 12 refused to have a random screen, 8 had detectable serum ethanol levels, and 3 had self-reported alcohol use. On multivariable analysis, a higher number of random BAL-checks [RR = 0.63(0.52, 0.76), P = 0.001] and a longer duration of prelisting abstinence [RR = 0.88(0.83, 0.94), P = 0.001] independently reduced the risk of alcohol use by patients while on the waiting list. None of the patients with >24 months of prelisting abstinence had a positive screen. In conclusion, this study supports random BAL-screening before transplantation and reinforces the importance of abstinence duration as a predictor of relapse. For patients with <24 months of prelisting abstinence, our center will increase the frequency of random BAL screening and increase the rehabilitation requirements to include an intensive 3-week rehabilitation program. We hope that these measures will reduce the rate of relapse to alcohol use post-transplantation. Liver Transpl 16:91-97, 2010.

Download Alcohol and transplant

Alcohol and Cancer: A Podcast

There is growing research pointing towards alcohol intake and cancer-especially in women. The recommended allowance daily is one alcoholic beverage for women, and two for men. Download Alcohol cancer .

A look at data for over 1 million women in the UK indicates that drinking alcohol -- even low amounts -- increases the risk of certain cancers in women.

According to the data released today, about 13 percent of the cancers of the breast, liver, rectum, and upper respiratory/gastrointestinal system may be related to alcohol use.

In their analysis of 1,280,296 middle-aged women from the so-called Million Women Study, Dr. Naomi E. Allen and colleagues from the University of Oxford found that 24 percent of participants reported no alcohol consumption. Women in the study who did drink alcohol consumed, on average, one drink per day. Very few drank three or more drinks per day.

During an average follow-up time of more than 7 years, 68,775 women were diagnosed with cancer.  Read more.

You Almost Made It...Penny

Let's just say Penny is a 60ish female with alcoholic cirrhosis. She had been a patient of mine for years. We first met when she had, what I thought would be, he last battle with the bottle. Back then, she presented with acute alcoholic hepatitis. Once she recovered from this acute event, we had a long talk and I told her that her ticket to like would have to be free of alcohol. Over time, she recovered from he liver insult from her heavy drinking ways, and for a few years, did well.

I saw her once or twice yearly when she flew into Houston to see me. She was happy in retirement, playing golf and relaxing. Every time we encountered, I was obligated to ask about alcohol. Every answer from her was NO!

Penny was evaluated for liver transplantation during her first bout with liver disease, and remained on the "list", even though her MELD score was relatively low (reflecting good liver function). Before listing for transplant, she was required, and completed, six months of Alcoholics Anonymous, with continued attendance.

This past spring, problems developed.

She was showing signs of worsening liver function, complicated by infections and gastrointestinal bleeding. One thing lead to another and she was eventually transferred to Houston for more intensive care. Upon question of the family and Penny herself, he had returned to active drinking for the past two years. Considering the clinical deterioration, this made sense.

I felt betrayed by this revelation. Time after time I questioned her sobriety. Nurses did the same. There were denials from everyone. I always told her that if she resumed destructive alcohol abuse, she would never be transplanted and have a miserable death. In the end, all of this came true. She died a terrible death, without any mention of a transplant.

Nationally, those of us in liver transplantation adopted the "six-month rule", mandating this time frame of active relapse prevention. Once completed and documented, formal listing for transplant could be discussed. Any break in this, and transplant is out.

The lesson here to learn is that if you have alcoholic liver disease and suffer from alcoholism, abstinence must be life-long. In many cases, the liver can recover and you dodge the transplant bullet. Feeling wonderful once your liver recovers could be a signal to start drinking again. Refrain from this. This is a scenario I see too often, and it does happen. Trust me.

Death by end-stage liver disease is dramatic. Transplantation is a wonderful gift and tool we have. It's use will always be reserved for the best candidates. We are not selecting against alcoholics. There's a system in place to deal with them. Falling off the wagon ends the discussion.

Penny is a fictitious name change to protect patient identity.