Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Aug 18, 2015; 7(17): 2091-2099
Published online Aug 18, 2015. doi: 10.4254/wjh.v7.i17.2091
Addiction specialist's role in liver transplantation procedures for alcoholic liver disease
Geert Dom, Hendrik Peuskens
Geert Dom, Collaborative Antwerp Psychiatric Research Institute, Antwerp University, 2610 Wilrijk, Belgium
Hendrik Peuskens, Psychiatry Department, University of Leuven, 3000 Leuven, Belgium
Author contributions: Dom G and Peuskens H both contributed to this paper.
Conflict-of-interest statement: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Geert Dom, MD, PhD, Collaborative Antwerp Psychiatric Research Institute, Antwerp University, Universtiteitsplein 1, 2610 Wilrijk, Belgium.
Telephone: +32-3-4557531 Fax: +32-3-4542084
Received: April 26, 2015
Peer-review started: April 28, 2015
First decision: June 25, 2015
Revised: July 24, 2015
Accepted: August 10, 2015
Article in press: August 11, 2015
Published online: August 18, 2015

Although liver transplantation (LT) is performed increasingly for patients with end-stage alcoholic liver disease (ALD), the topic remains controversial. Traditionally, the role of an addiction specialist focused on the screening and identification of patients with a high risk on relapse in heavy alcohol use. These patients were in many cases subsequently excluded from a further LT procedure. Recently, awareness is growing that not only screening of patients but also offering treatment, helping patients regain and maintain abstinence is essential, opening up a broader role for the addiction specialist (team) within the whole of the transplant procedure. Within this context, high-risk assessment is proposed to be an indication of increasing addiction treatment intensity, instead of being an exclusion criterion. In this review we present an overview regarding the state of the art on alcohol relapse assessment and treatment in patients with alcohol use disorders, both with and without ALD. Screening, treatment and monitoring is suggested as central roles for the addiction specialist (team) integrated within transplant centers.

Keywords: Liver transplantation, Alcohol use disorder, Alcoholic liver disease, Relapse, Addiction specialist

Core tip: Liver transplantation is performed increasingly for patients with end-stage alcoholic liver disease. Assessment of a patients risk on relapse in alcohol use after transplantation and helping patients to achieve and maintain abstinence are crucial within this process. The addiction specialist’s input is essential and needs to be integrated within the transplantation team. Ideally a multidisciplinary approach is offered to the patients, including addiction psychiatrist, behavioral therapist and social worker following up the patient before and after transplantation.