1.6.2 Treating alcohol-related liver disorders
Although considerable progress has been made in the treatment of many other chronic medical conditions, scant progress has been made in the treatment of cirrhosis. In over 8000 people admitted to hospitals in the Oxford region of the UK with liver cirrhosis during a 30-year observation period, 34 per cent had died one year after their admission and this death rate remained more or less constant (Roberts et al., 2005).
The largely pessimistic view of the failure of treatment of liver damage may change as there is evidence (Iredale, 2003) that the underlying processes, such as inflammation, are becoming increasingly understood, and may potentially be reversible in the future. However, it is clear that at the moment, no really effective medication currently exists to reverse the damage produced by alcohol and the best hope for long-term health for Rachael and other problem drinkers remains abstinence from drinking alcohol.
If Rachael continues to drink alcohol the fatty infiltration of her liver may progress to cirrhosis (Teli, 1999). When cirrhotic liver damage becomes severe, liver transplantation might be possible. Because of the limited availability of livers for transplantation some specialist units have a rule that people should demonstrate their resolve and not drink alcohol for a fixed period of time (perhaps six months), before the transplant is considered. This type of rule, with its rather moralistic overtones, has been challenged by Webb and Neuberger (2004). Other people may be not considered suitable for liver transplant because they have other physical or psychological problems (Walsh and Alexander, 2000).
Transplantation is a simple idea but replacing a diseased organ with a fully functioning one from a donor can be complicated in practice. As you can imagine there are many ethical dilemmas involved in taking organs from heart-beating but brain-dead people. Many of the potential medical problems arise after transplantation because the host person's body will consider the new organ to be ‘non-self’ and attempt to reject it. Although rejection can be controlled by immunosuppressive drugs, these often have side-effects. Despite these difficulties many people with a liver transplant lead entirely normal, active lives (Prasad and Lodge, 2001).
If Rachael's liver damage becomes so severe that she has to have a liver transplant then the outlook is surprisingly good. Approximately 75 per cent of people with a new liver will be alive five years after the transplant surgery (Iredale, 2003), and progress with new surgical techniques and immunosuppressive drugs continues to improve the chances of survival. However, research has shown that between 8 per cent and 22 per cent of people are found to drink alcohol within six months of their transplant, and overall between 10 per cent and 30 per cent; relapse in due course (Webb and Neuberger, 2004). Let us hope that Rachael is able to get the right information, treatment and support to help her live a long and happy life.