Dr. Gerald Winder of Michigan Medicine in Ann Arbor, coauthor of a related editorial, commented in an email to Reuters Health, "Alcohol relapses after liver transplant (LT) are emotionally radioactive for many clinicians in the field of hepatology and LT."
"The argument can be made that most of us will be more incredulous, angry, and judgmental toward the alcohol liver patient who drinks after their liver transplant than the metabolic-associated fatty liver disease patient who returns to a diet of cheeseburgers and milkshakes post-transplant."
"Yet, these hypothetical cases are foundationally similar in that the recipients are engaging in nonadherent and risky health behaviors and are not being good stewards of their organ," he said. "We clinicians need to come to terms with how we feel about these patients since it can affect how we engage with them, discuss their treatment, and follow-up on their care."
"If our therapeutic alliances with (these) patients weaken because of how we think and talk about them, they are only less likely to tell us if they need help, which just accentuates the downstream risk of negative outcomes, which then just fuels the field’s frustration with this patient population," he said. "A spiral could ensue."