However, not all recipients are able to maintain sobriety. Alcohol relapse can have a number of negative impacts, including: (i) liver dysfunction secondary to alcohol toxicity; (ii) non-compliance with medications or clinic visits; (iii) rejection secondary to non-compliance; (iv) graft failure secondary to rejection or alcohol toxicity; and (v) malignancies and cardiovascular diseases possibly related to smoking, which is highly associated with alcohol relapse.[2] The perception that recipients will relapse may also decrease the willingness of others to donate organs. Reports have differed in both the definitions

buy Kinase Inhibitor Library used for harmful drinking and its effects after LT. Shmeding et al. and Cuadrado et al. defined problem drinking by amount of alcohol[5, 6] and showed significantly lower survival in patients with problem drinking. On the other hand, Pageaux et al. reported no significant difference in

actual survival among heavy drinkers, occasional drinkers and abstinent patients.[7] De Liproxstatin-1 cell line Gottardi et al. defined harmful drinking as existence of alcohol-related damages like our definition and found no significant difference in patient survival.[3] In this study, we tried to minimize the effects of differences in follow-up periods and alcohol consumption periods, and defined problem drinking by the existence of final damages related to alcohol consumption. Although there are still limitations, the impact on survival and risk factors of harmful drinking were revealed in this study.

Pretransplant abstinence shorter than 18 months and smoking after transplantation were significant indicators for harmful relapse. Webb et al. noted that resumption of problem drinking can lead to non-compliance with the transplant almost follow-up program,[8] which can in turn lead to rejection. In our study, the incidence of non-compliance with immunosuppressant was significantly greater in patients with harmful relapse in univariate analysis but the incidence was not significant in multivariate analysis. Our previous report showed similar incidence of rejection between patients with abstinence and recidivism.[2] However, this finding is important to construct the best follow-up program after LT for ALC. Cuadrado et al. reported significantly lower patient survival in patients with alcohol relapse and suggested that alcohol consumption and tobacco use might have contributed to the cancer and cardiovascular events that were frequent causes of death.[6] In our study, one patient with harmful relapse died due to myocardial infarction, one patient with abstinence died due to subarachnoid hemorrhage, and four patients with abstinence and one patient with non-harmful relapse died due to malignancies. Post-transplant smoking was significantly often associated with harmful relapse. Careful follow up focusing on malignancy and cardiovascular complications is recommended after LT for ALC.