Ongoing Management

Complications of portal hypertension

As with other types of liver disease, complications of portal hypertension should be considered and managed appropriately, such as:

• Encephalopathy
• Oesophageal varices
• Ascites and liver synthetic function derangement
• Hypoglycaemia
• Coagulopathy

should be considered and managed appropriately.

Caution should be taken when diagnosing encephalopathy in this patient group as the differentials include subdural haematoma, Wernicke’s encephalopathy and delirium tremens [1].

Liver transplantation

Liver transplantation is the only curative treatment for advanced ALD, however current or recent substance abuse is a contraindication for transplant. Selection requires a multi-disciplinary team approach including a hepatologist, surgeon, addiction specialist, psychiatrist and social worker. Patients must be motivated and compliant with immunosuppressive treatment [4].

Relapse of alcoholism after transplant is sadly common, the best predictor for continued sobriety after transplantation is a period of 6 months or longer documented abstinence [1,5].

Alcohol interferes with compliance and metabolism of immunosuppressive medications and recipients who succumb to alcoholism often rapidly develop liver damage in the graft including cirrhosis [1,4].

Learning Bite

Liver transplant is the only hope for cure in advanced ALD.