Successful Post-Transplant Psychiatric Interventions During Long-Term Follow-Up of Patients Receiving Liver Transplants for Alcoholic Liver Disease
Unusual setting of medical care
Hiroyuki Kimura, Yasuharu Onishi, Shinichi Kishi, Nobuhiko Kurata, Satoshi Ogiso, Hideya Kamei, Chisato Tsuboi, Naoko Yamaguchi, Azusa Shiga, Mai Kondo, Yushun Yokoyama, Fumika Takasato, Hiroshige Fujishiro, Kanako Ishizuka, Takashi Okada, Yasuhiro Ogura, Norio Ozaki
Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
Am J Case Rep 2017; 18:1215-1219
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.
Keywords: Alcohol Abstinence, Liver Transplantation, Patient Care Team, Preventive Psychiatry