Successful Post-Transplant Psychiatric Interventions During Long-Term Follow-Up of Patients Receiving Liver Transplants for Alcoholic Liver Disease

Case series Patient: Male, 44 • Male, 44 • Female, 36 Final Diagnosis: Alcohol use disorders in sustained remission Symptoms: Relapse of alcohol use • stress-related anger/irritation • zolpidem abuse Medication: — Clinical Procedure: Psychiatric intervention Specialty: Transplantology OBJECTIVE: Unusual setting of medical care BACKGROUND: Around 20–30% of patients who undergo liver transplantation (LT) for alcoholic liver disease (ALD) will resume heavy drinking after LT. It is crucial to control post-transplant relapse of alcohol use, because alcoholic recidivism has been shown to have a negative impact on post-transplant compliance and long-term outcomes of LT recipients. However, there is currently no specific, effective psychiatric intervention for preventing additional alcohol consumption in clinical practice. CASE REPORT: We present 3 patients who underwent LT for ALD at Nagoya University Hospital who were followed up for prolonged periods (7.2, 8.8, and 11.3 years, respectively), and review the psychiatric interventions employed to address critical situations. Additional alcohol consumption was noted in Case 1, but prompt collaborative care led to stable abstinence. In Case 2, marked anger and irritation were exacerbated as a result of work, but the anger was controlled by anger management. Case 3 abused a minor tranquilizer, but limit-setting resulted in adequate medical adherence. CONCLUSIONS: Transplant teams need to provide comprehensive treatment for alcoholic recidivism to improve long-term health after LT for ALD.