• Claire Vanlemmens, Vincent Di Martino, Chantal Milan, Michel Messner, Anne Minello, Christophe Duvoux, Thierry Poynard, Jean-Marc Perarnau, Marie-Anne Astrid Piquet, Georges-Philippe Pageaux, Sébastien Dharancy, Christine Silvain, Sophie Hillaire, Gérard Thiefin, Jean-Pierre Vinel, Patrick Hillon, Estelle Collin, Georges Mantion, Jean-Philippe Miguet, and TRANSCIAL Study Group.
• Centre Hosptialier Universitaire Jean Minjoz, Besançon, France.
• Ann. Intern. Med. 2009 Feb 3;150(3):153-61.

BackgroundLiver transplantation improves survival of patients with end-stage (Child-Pugh stage C) alcoholic cirrhosis, but its benefit for patients with stage B disease is uncertain.ObjectiveTo compare the outcomes of patients with Child-Pugh stage B alcoholic cirrhosis who are immediately listed for liver transplantation with those of patients assigned to standard treatment with delay of transplantation until progression to stage C disease.DesignRandomized, controlled trial.Setting13 liver transplantation programs in France.Patients120 patients with Child-Pugh stage B alcoholic cirrhosis and no viral hepatitis, cancer, or contraindication to transplantation.InterventionsPatients were randomly assigned to immediate listing for liver transplantation (60 patients) or standard care (60 patients).MeasurementsOverall and cancer-free survival over 5 years.ResultsSixty-eight percent of patients assigned to immediate listing for liver transplantation and 25% of those assigned to standard care received a liver transplant. All-cause death and cirrhosis-related death did not statistically differ between the 2 groups: 5-year survival was 58% (95% CI, 43% to 70%) for those assigned to immediate listing versus 69% (CI, 54% to 80%) for those assigned to standard care. In multivariate analysis, independent predictors of long-term survival were absence of ongoing alcohol consumption (hazard ratio, 7.604 [CI, 2.395 to 24.154]), recovery from Child-Pugh stage C (hazard ratio, 7.633 [CI, 2.392 to 24.390]), and baseline Child-Pugh score less than 8 (hazard ratio, 2.664 [CI, 1.052 to 6.746]). Immediate listing for transplantation was associated with an increased risk for extrahepatic cancer: The 5-year cancer-free survival rate was 63% (CI, 43% to 77%) for patients who were immediately listed and 94% (CI, 81% to 98%) for those who received standard care.LimitationRestriction of the study sample to alcoholic patients may limit the generalizability of results to other settings.ConclusionImmediate listing for liver transplantation did not show a survival benefit compared with standard care for Child-Pugh stage B alcoholic cirrhosis. In addition, immediate listing for transplantation increased the risk for extrahepatic cancer.FundingThe French National Program for Clinical Research.

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