Will Best's liver last?

Football legend George Best is drinking again, just 16 months after his controversial liver transplant.

The 57-year-old former Manchester United player, who pledged he had abandoned drink forever after receiving a precious donated liver, went on yet another well-publicised drinking spree last week.

During his binge, he reportedly vandalised his estranged wife's car before heading to London, where he was robbed by two women in his hotel room. So what is the likely outcome for George now that he is back on the bottle, and how long is his new liver going to last?

Q: Why did George Best need a liver transplant?

A: The footballer was given just months to live in spring 2002 after his liver was destroyed by years of alcohol abuse. In July 2002, he had a liver transplant at the Cromwell Hospital in London.

Q: Why does alcohol damage the liver?

A: The liver breaks down alcohol in the bloodstream and converts it into water and carbon dioxide.

But high concentrations of alcohol can damage the liver over time. Most heavy drinkers will develop a fatty liver.

If patients continue drinking excessively, then about 20 to 30 per cent will develop the next stage of alcoholic liver disease, known as alcoholic hepatitis. Around ten per cent, including George Best, will develop cirrhosis, a permanently scarred and damaged liver. This is fatal without treatment.

Q: Why was his transplant controversial?

A: Not everyone who needs a new liver can have one, and many thought that George Best did not deserve a transplant because he had not yet overcome his addiction.
Although 692 people in the UK did undergo a liver transplant in 2002-3, 220 people remained on the waiting list and some people died. George's doctor, Professor Roger Williams, defended his patient at the time, saying he trusted him to stay sober.

Q: Did George have to stop drinking before he qualified for a liver transplantation?

A: George Best did give up drinking for a year before his operation, but there is no absolute requirement.

According to UK Transplant, the Government body that draws up national guidelines for transplants, there are only three essential criteria.

Patients must have a greater than 50 per cent chance of surviving for five years after the transplant, they should be likely to die within a year if they do not get on the transplant list and they must already have an unacceptable quality of life.

Q: What would George have been told after his operation?
A: All transplant patients need to follow strict health guidelines because they need to take immuno-suppressant drugs, making them more vulnerable to infection.

As a liver transplant patient, he would also have been told to steer clear of alcohol. Anti rejection drugs make the body less efficient at processing food and alcohol. Also he had already shown that he found it difficult to control his alcohol intake.

Q: George Best was prescribed a special anti-alcohol drug, Antabuse, which was implanted in his stomach after the transplant to make him sick when he touches alcohol. Is this normal?
A: This is extremely unusual. Most people with alcoholic liver disease who have a transplant must show they have kicked their addiction.

'This is used in addiction clinics, not transplant units,' says Simon Bramhall, consultant liver transplant surgeon at Birmingham Liver Unit. 'We would never consider giving anyone a transplant who needed to take this drug. George was very lucky that his doctor allowed this.'

Q: Why did the implants fail?
A: The implants release a steady amount of a chemical called disulfiram, which interferes with the way alcohol breaks down in the body. Disulfiram makes alcohol have nasty effects like headaches and vomiting. 'The implants do work but they need to be replaced every three months and they may get less effective towards the end of that time,' says Professor Williams.

Q: What happens to the transplanted liver after a patient starts drinking again?

A: The new liver can cope with alcohol quite well and moderate drinking is not going to cause a health problem. 'Transplanted livers are not more vulnerable than other livers,' says Simon Bramhall. 'George could drink moderately for the rest of his life and stay healthy.'

Q: How long will it take George to start suffering from liver disease again?

A: His drinking could kill him in years or decades, but it depends on all kinds of factors, like how much he drinks over time.

Q: Now that George Best has slipped up, is he doomed to failure?

A: Professor Williams believes he could get back on track with no ill-effects, as long as he stops drinking.

Unfortunately, he is not able to guarantee that his patient will follow the rules. 'I would much prefer George not to drink,' he says, 'but I can't make any predictions at this stage.'

NHS Organ Donor Register: tel. 0845 6060400.