Alcohol Abstinence and Orthotopic Liver Transplantation in Alcoholic Liver Cirrhosis

Immordino, Giovanni; Gelli, Maximiliano; Ferrante, Rossella; Ferrari, Carlo; Piaggio, Francesca; Ghinolfi, Davide; Sturdevant, Mark; Andorno, Enzo; Morelli, N; Bottino, Giovanni; Casaccia, M.; Valente, Umberto

doi:10.1016/j.transproceed.2009.03.092

Cited by 22 publications

(16 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…About 7.2% (8 cases) had histological evidence of AH on the explants. Comparison of these 8 cases with the remaining 102 cases without histological AH in the explants showed similar patient survival post-OLT recidivism [20] . Similar data have been reported by other investigators [21][22][23] .…”

Section: Data On Liver Transplantation In Alcoholic Hepatitismentioning

confidence: 75%

Liver transplantation in acute alcoholic hepatitis: Current status and future development

Singal

Duchini

2011

WJH

View full text Add to dashboard Cite

Acute alcoholic hepatitis (AH) is a distinct clinical entity amongst patients with chronic alcohol abuse. Patients with severe AH are at risk of dying in about 20%-25% cases despite specific treatment with corticosteroids and/or pentoxifylline. Clearly, a need for an additional more effective treatment option is unmet currently. Liver transplantation (LT), a definitive treatment option for alcoholic cirrhosis requires 6 mo abstinence. However, this rule cannot be applied to patients with AH as these patients are actively drinking prior to their presentation. Shortage of donors, ethical issues, and fear of recidivism after transplantation with less than 6 mo pretransplant abstinence are some of the reasons behind this rule of 6 mo of abstinence and hesitancy of transplanting patients with AH. These issues are debated at length in this manuscript. Further, retrospective studies have shown that patients undergoing transplantation for alcoholic cirrhosis and having histological changes of AH have been shown to fare as well when compared to patients without these histological changes. Recently, French workers have reported a case matched prospective study showing encouraging data on the usefulness of LT for patients who are non-responders to corticosteroid and/or pentoxifylline therapy. Future studies are needed to identify patients with severe AH who are going to benefit most with LT. In the light of emerging data on the efficacy of LT in improving survival of patients with severe acute AH who do not respond to corticosteroids, the time is ripe to re-evaluate our policy of LT in patients with AH.

show abstract

Section: Data On Liver Transplantation In Alcoholic Hepatitismentioning

confidence: 75%

Liver transplantation in acute alcoholic hepatitis: Current status and future development

Singal

Duchini

2011

WJH

View full text Add to dashboard Cite

show abstract

“…We screened 1130 references; 485 were selected for full-text retrieval. Of these, 11 were included in the analysis [2,7,10,11,[20][21][22][23][24][25][26]. One study [27] which was a national registry that included patients from 2 other studies [7,21] was excluded to avoid duplication of data.…”

Section: Discussionmentioning

confidence: 99%

Liver transplantation for alcoholic hepatitis: a systematic review with meta-analysis

Astrid¹,

Margaux²,

Eric³

et al. 2018

Journal of Hepatology

View full text Add to dashboard Cite

BackgroundThe rate of alcohol relapse among patients who underwent liver transplantation for alcoholic hepatitis (AH) is not precisely known. AimSynthesize the available evidence on liver transplantation for AH to assess alcohol relapse and 6-month survival. MethodsMeta-analysis of trials evaluating liver transplantation for AH, either clinically severe or diagnosed on the explant. OPEN ACCESS Citation: Marot A, Dubois M, Trépo E, Moreno C, Deltenre P (2018) Liver transplantation for alcoholic hepatitis: A systematic review with metaanalysis. PLoS ONE 13(1): e0190823. https://doi. ConclusionUsing stringent selection criteria, 14% of patients with clinically severe AH have alcohol relapse after liver transplantation. The percentage of alcohol relapse of AH transplanted patients is similar than that of patients who underwent elective liver transplantation. DF, Maddrey's discriminant function; NA, not available; OR, odds ratio.

show abstract

“…These publications often fail to recognize and define AUD, which is different from quantification of drinks, and do not account for concurrent medical treatment of AUD . Studies investigating ALD often use heterogeneous clinical definitions . Although this may improve with the National Institute on Alcohol Abuse and Alcoholism (NIAAA) AH Consortia recommendations for defining the study of AH, future studies outside of the population with AH lack guidance.…”

Section: Proposed Comprehensive Ald Data Collection Toolmentioning

confidence: 99%

“…(4,5) Studies investigating ALD often use heterogeneous clinical definitions. (6,7) Although this may improve with the National Institute on Alcohol Abuse and Alcoholism (NIAAA) AH Consortia recommendations for defining the study of AH, (8) future studies outside of the population with AH lack guidance. Reliance on clinical definitions also appears to be of limited accuracy.…”

mentioning

confidence: 99%

A Call to Standardize Definitions, Data Collection, and Outcome Assessment to Improve Care in Alcohol‐Related Liver Disease

2019

View full text Add to dashboard Cite

Alcohol‐related liver disease (ALD) is highly prevalent and appears to be increasingly reported with worsening mortality; thus, optimizing care in this patient population is imperative. This will require a multidisciplinary, multifaceted approach that includes recognizing alcohol use disorder (AUD) and existing treatments for AUD. We must also acknowledge the full spectrum of ALD clinically and histologically. For example, our current clinical definitions of alcohol‐related hepatitis (AH) do not address that >95% of severe AH occurs in the setting of cirrhosis with <60% of liver explants having hepatitis. Given that the majority of ALD studies rely on clinical diagnosis and lack pathologic confirmation, prior data on the efficacy of medical treatment or use of transplantation are likely limited by intertrial and intratrial heterogeneity. Added limitations of the current field include the inconsistent reporting of relapse with the use of varying definitions and unreliable assessments. Moreover, studies fail to consistently capture the data variables that likely influence the main outcomes of interest in this population—mortality and relapse—and a global effort to create a standardized data collection tool moving forward could help effectively and efficiently aid in the advancement of this field. Conclusion: To optimize patient care and make best use of a limited resource, a systematic change in the approach to research in this population must be undertaken that creates consistent definitions for use in future research to generate reliable and reproducible results. With this in mind, we concisely reviewed the literature to summarize the current state of treating and managing ALD, the heterogeneity in definitions, and the significant opportunities for clinical and research improvement.

show abstract

Alcohol Abstinence and Orthotopic Liver Transplantation in Alcoholic Liver Cirrhosis

Cited by 22 publications

References 13 publications

Liver transplantation in acute alcoholic hepatitis: Current status and future development

Liver transplantation in acute alcoholic hepatitis: Current status and future development

Liver transplantation for alcoholic hepatitis: a systematic review with meta-analysis

A Call to Standardize Definitions, Data Collection, and Outcome Assessment to Improve Care in Alcohol‐Related Liver Disease

Contact Info

Product

Resources

About