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Background & Aims Beyond 5years, poorer survival, related to alcohol relapse, is observed in patients with liver transplant for alcohol-related liver disease (ALD). However, alcohol consumption has been significantly understudied in non-ALD transplant recipients. We aimed at analyzing the impact of alcohol consumption on long-term survival irrespective of the indication for transplantation. Methods This observational study included consecutive adult recipients of a primary liver graft between 1991 and 2007 in our hospital, who survived >6months. Patients without ALD as primary indication, but with a history of excessive alcohol consumption before transplantation, were classified as secondary indication ALD. We studied the impact on survival of excessive consumption of alcohol after transplantation and several other variables. Results The 441 patients had mean follow-up of 81.7months. Among the 281 patients with excessive alcohol consumption before transplantation, 206 had ALD as primary indication. After transplantation, alcohol consumption was reported by 32.3% of the study population, 43.7% in primary indication ALD, and 24.3% in non-ALD patients. Survival was 82% at 5years and 49% at 10years for patients with excessive alcohol relapse, compared with 86% and 75%, respectively, for patients without persistent excessive alcohol relapse. By multivariable analysis, the independent risk factors of death were: excessive alcohol relapse, age >51years, post-transplantation diabetes mellitus, cyclosporine-based immunosuppression, and non-hepatic cancer. Conclusions Excessive alcohol consumption has a negative impact on long-term survival after liver transplant, irrespective of the primary indication. Death is mainly due to recurrence of liver disease and non-hepatic cancer.

D. Larrey1, A. Salse1, G.P. Pageaux1, N. Funakoshi1, D. Ribard2, O. Boutet3, V. Hyrailles4, B. Niang5, E. Vaucher6, J.P. Arpurt7, A.J. Remy8, S. Dahmouni1, N. Kharlova9, J.P. Daures10. 1Liver Unit/School of Medecine, St Eloi Hospital/INSERMU632, Montpellier, 2Liver Unit, Nimes Hospital, Nimes, 3Liver Unit, Bagnols sur Ceze Hospital, Bagnols sur Ceze, 4Liver Unit, Beziers Hospital, Beziers, 5Liver Unit, Ales Hospital, Ales, 6Liver Unit, Narbonne Hospital, Narbonne, 7Liver Unit, Avignon Hospital, Avigon, 8Liver Unit, Perpignan Hospital, Perpignan, 9Clinical Research, Laboratory Roche, Paris, 10Biostatistics Department, IURC, Montpellier, France E-mail: dom-larrey@chu-montpellier.fr