Peripheral neuropathy in a patient with alcoholic cirrhosis is reversible

Dec 1 2004

Organ damage that goes beyond the liver due to alcoholism is often seen as a barrier to liver transplantation, despite a lack of data on how a transplant affects these complications.

A new study describes a patient with alcoholic liver disease complicated by peripheral neuropathy (nerve damage affecting the arms and legs) who underwent a liver transplant and regained almost normal muscle strength.

The results of this study appear in the December 2004 issue of Liver Transplantation, the official journal of the American Association for the Study of Liver Diseases (AASLD) and the International Liver Transplantation Society (ILTS). The journal is published on behalf of the societies by John Wiley & Sons, Inc. and is available online via Wiley InterScience.

Edward Gane, hepatologist at the New Zealand Liver Transplant Unit, and David Hutchinson, neurologist, report the case of a 50-year-old male patient with a 20-year history of drinking more than 100g of alcohol per day who had end-stage liver disease and weakness in both legs. When his condition continued to deteriorate after nine months of abstinence from alcohol, he was evaluated for a liver transplant. At this point, his neuropathy had progressed to the point where he could not rise from a chair without using his arms and had considerable difficulty climbing stairs. Liver transplants are usually not performed on patients with this type of complication because it is thought to be irreversible, although to date, very few studies have been conducted to verify this assertion.

Despite the patient's poor prognosis and continued deterioration, he underwent a liver transplant in December 1999. Following the transplant, he noticed progressive recovery of strength in both legs. He was able to walk unaided after two months, and after six months he could rise from a chair and negotiate stairs normally. Neurological exams 12 months following the transplant showed significant improvement in motor function.

The authors maintain that the patient's neuropathy was due not just to alcohol, but that liver failure played a major role in the disease. Symptoms of both conditions progressed simultaneously and the neuropathy had failed to improve despite nine months of abstinence, but did improve following the transplant.

"We initially considered the peripheral neuropathy in our patient to be a contraindication to OLT [orthotopic liver transplantation] due to its significant impact on his quality of life and the uncertainty about its prognosis following transplantation," the authors conclude. "Our experience with this patient suggests that peripheral neuropathy in a patient with alcoholic cirrhosis is reversible and should not constitute a contraindication to OLT, even when the neuropathy is disabling."