The study involved patients selected from seven centers for early liver transplantation. All had no prior episodes of alcoholic hepatitis and were assessed at having a high risk of death.
Twenty-six of patients at risk of death were placed on a list for liver transplant. The cumulative six-month survival rate was higher in those who had undergone transplant surgery. Follow-up showed this was maintained for two years.
Three patients resume drinking alcohol: one at 720 days and one at 740 days and one at 1,140 days after transplantation. Two patients died from infection.
About 50 percent of all liver transplants are related to alcohol-induced disease, according to Dr. David Cronin, director of liver transplants at Froedtert and the Medical College of Wisconsin.
"The dilemma is that livers that are available for transplants in a limited supply," said Cronin. "Many people on the list have -- in quotes -- paid their dues. They have done what they were supposed to do to get evaluated. They have changed their social behavior and are waiting."
The question of "worthy" must be considered with the one of "utility," he said.
Patients should have an 85 percent chance of expected success. "This is not a salvage operation," said Cronin. "The sicker you are, the higher rate of dying."
Alcoholics with chronic liver disease may not be good transplant patients.
"Substance abuse is associated with self-destructive behavior and noncompliance," he said. "If you give them a liver transplant, they won't maintain employment and show up for visits and take their medications and the graft ends up failing."
But in patients with acute alcoholic hepatitis, which can also be caused by a one-time event like a virus or eating mushrooms or other drugs, the success rate may be higher.
Cronin, as the study concludes, said it takes a "highly selected" type of patient, with strong family support to keep them off alcohol.
"We will take a chance with this group," he said. "If they don't get a transplant, a certain subset in the group will die… We are in the life-preserving game. We should always -- physicians and society -- strive to preserve life... That is our duty."
Cronin said the liver transplant can be a "life-changing event" for those who realize "they made a mistake."
Such was the case with another one of Teperman's liver transplant patients in 1997 at New York University -- a woman who in her 20s who had acute alcoholic hepatitis.
"She was young and there were some emotional issues that had taken place," he said. "But she had the belief and support of her family and a rehab doctor and a psychiatrist who said this had caused a wonderful woman just to over the deep end. They were all behind her."
Now, more than decade later, she is healthy and thriving – without alcohol.