Evaluation of efficacy of liver transplantation in alcoholic cirrhosis using matched and simulated controls: 5-year survival

Background/Aims: Alcoholic cirrhosis is the most common cause of liver transplantation in US males. The limited number of donor livers calls for“prioritisation”, favouring those patients who will benefit most. The aim was to assess the efficacy of liver transplantation in patients with alcoholic cirrhosis. Methods: We compared the survival of 169 transplantedpatients with two conservatively treated control groups, one of 169 patients matched for prognostic factors (age, cirrhosis severity, bleeding history) and one of 169 simulated patients. Results: The probability of survival to 5 years in the transplanted group was 66% (95% confidence interval 58–74%) vs 52% (44–60; p=0.03) in the matched group and 54% (51–57; p=0.01) in the simulated controls. Transplantation was associated with survival (relative RISK=1.51; p=0.02), independently of risk score (risk=2.07; p<0.001), indication, period of inclusion, centre experience, and alcohol abstinence. Patients with severe disease (Pugh C11–15) benefited most in terms of 5-year survival: 58% (44–72) vs 31% (17–45; p=0.008) in the matched and 35% (30–40; p<0.001) in the simulated control groups. For patients at lower risk there was no significant difference. Conclusions: Liver transplantation increases the 5-year survival of patients with severe alcoholic cirrhosis. In patients at lower risk, efficacy of transplantation should be confirmed by longer follow-up or by randomised trial.