Alcohol is metabolized by several processes or pathways. The most common of these pathways involves two enzymes—alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH). These enzymes help break apart the alcohol molecule, making it possible to eliminate it from the body. First, ADH metabolizes alcohol to acetaldehyde, a highly toxic substance and known carcinogen (1). Then, in a second step, acetaldehyde is further metabolized down to another, less active byproduct called acetate (1), which then is broken down into water and carbon dioxide for easy elimination (2). from NIAAA
Effects of Alcohol on the Liver
You liver doesn’t metabolize alcohol as soon as it gets to the liver. It has to change it into other substances to get the alcohol (ETOH) out of your body (ETOH is ethyl alcohol, the kind we drink for pleasure). What this means is that the molecules ADH and ALDH are created in liver cells, the molecules than have to tear out of the liver cells to be released. The liver is designed to do this, but not at the level that an alcoholic drinks. That level causes damage.
There are two ways to overwork your liver with alcohol. One is acute fatty liver. Acute means it is bad but will heal itself. This is what happens after a weekend bender. Cirrhosis is what happens next. It is when your liver is so busy processing alcohol that it has no opportunity to heal itself. At this time the liver is being scarred and that scarring cannot be repaired, so that portion of the liver does not work anymore.
If one portion of the liver is not working, but the same amount of alcohol is being sent to it, the other parts have to work harder. This hastens their scarring. It is why people with cirrhosis have to quit drinking (for that matter they have to stop doing all things that tax the liver) or they will die.
Why death instead of a transplant.
Because of a shortage of donor organs, OLT for ALD patients remains controversial out of concerns that patients may resume drinking, thereby harming the transplanted organ. Therefore, transplant centers conduct careful screening procedures that assess patients’ coexisting medical problems and psychosocial status to identify those patients who are medically most suited for the procedure and who are most likely to remain abstinent after OLT. from NIAA
Because of this screening process many alcoholics will not be allowed a donor liver.
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