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Controversies in Early Liver Transplantation for Severe Alcoholic Hepatitis
- Source :
- Annals of Hepatology, Vol 17, Iss 5, Pp 759-768 (2018)
- Publication Year :
- 2018
- Publisher :
- Elsevier BV, 2018.
-
Abstract
- Alcoholic hepatitis (AH) is a condition of acute liver inflammation in the setting of heavy alcohol use that is often managed with corticosteroids in severe cases. Among non-responders to steroids, however, prognosis is poor with up to 75% mortality within 6 months after treatment failure. Early liver transplantation (LT) can achieve an acceptable short-term survival, and initial studies have demonstrated 3-year survival rates of up to 84%. However, the practice of early LT in severe AH remains controversial with concerns over the 6-month rule of sobriety and risk of alcohol relapse post-transplant. Proponents of LT advocate for better understanding of alcohol use as a disorder rather than self-inflicted cause of illness, aim to redefine the misguided application of the 6-month rule, and point out similar relapse rates among patients with early LT and those with greater than 6 months abstinence before transplant. Opponents of LT emphasize the correlation between alcohol relapse and graft failure and mortality, public resistance and potential for distrust among donors, and arguments that transplant centers need to establish improved models to predict relapse and standardize candidate selection criteria across centers. Here we review recent literature on this controversy and provide recommendations for moving forward to consensus.
- Subjects :
- medicine.medical_specialty
Time Factors
Graft failure
Heavy alcohol use
media_common.quotation_subject
medicine.medical_treatment
Clinical Decision-Making
Specialties of internal medicine
Alcoholic hepatitis
Outcomes
Alcohol use disorder
030230 surgery
Liver transplantation
Severity of Illness Index
Decision Support Techniques
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
Sobriety
Recurrence
Risk Factors
medicine
Humans
Intensive care medicine
Early liver transplantation
media_common
Hepatology
Alcohol Abstinence
Hepatitis, Alcoholic
business.industry
Patient Selection
Graft Survival
General Medicine
Abstinence
medicine.disease
Liver Transplantation
Treatment Outcome
RC581-951
Six-month rule
Steroids
030211 gastroenterology & hepatology
business
After treatment
Subjects
Details
- ISSN :
- 16652681
- Volume :
- 17
- Database :
- OpenAIRE
- Journal :
- Annals of Hepatology
- Accession number :
- edsair.doi.dedup.....f5b53d28af1062af8cb7ee7daee7f75b