To the Editor.—
Starzl et al1 make some points in their article on liver transplantation for alcoholics that merit discussion on both factual and methodological grounds. The prognosis of patients with alcoholic cirrhosis is debated widely in the transplant community, and, thus, any objective data to guide those involved in patient selection with regard to this issue would be most welcome. Unfortunately, the article by Starzl et al cannot serve this purpose because of its methodological inadequacies. No data are provided, either systematically or informally, confirming or quantifying alcoholism. Specifically, no information was gathered as to whether patients are currently drinking or how much, or the extent of adverse consequences, although valid instruments for this purpose have long been available.2,3 Starzl et al not only failed to measure alcohol use before transplantation, they also did not use any objective measures of alcohol use after transplantation (eg, blood alcohol
Olbrisch ME, Levenson JL. Liver Transplantation for Alcoholic Cirrhosis. JAMA. 1989;261(20):2958. doi:10.1001/jama.1989.03420200048032
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