Outcomes after liver transplantation for alcoholic hepatitis are similar to alcoholic cirrhosis: Exploratory analysis from the UNOS database

Singal, Ashwani K.; Hmoud, Bashar; Anand, Bhupinderjit S.; Jampana, Sarat; Singal, Vineet; Kuo, Yong Fang

doi:10.1002/hep.25544

Cited by 161 publications

(125 citation statements)

References 25 publications

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“…The overall recidivism rate with relapse was 12%, with no case of alcoholic relapse within the initial six-month follow-up period after LT. Similar survival rates were reported in a retrospective study comparing LT outcomes for patients with alcoholic hepatitis to those with alcoholic cirrhosis (one year: 93% vs 88%; two years: 91% vs 84%; five years: 80% vs 78%) [48] . However, both studies mentioned an observable difference in society's readiness towards transplants for ALD and other self-inflicted liver diseases, despite their comparable mortality.…”

Section: Concerns On Lt For Acute Alcoholic Hepatitis Without An Abstsupporting

confidence: 81%

“…Medical treatment including the use of corticosteroids and/or pentoxifylline reduces the mortality rate to approximately 20%-30% [43,47] . Non-responsive patients suffer high mortality, and thus LT for alcohol hepatitis has been proposed in select patients [35,47,48] . However, alcoholic hepatitis is a controversial indication, or even a contraindication, for LT in most institutions [49,50] due to the high potential for alcohol recidivism, and conceivably due to the lack of pre-transplant abstinence period.…”

Section: Concerns On Lt For Acute Alcoholic Hepatitis Without An Abstmentioning

confidence: 99%

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Perceptions of post-transplant recidivism in liver transplantation for alcoholic liver disease

Kawaguchi¹,

Sugawara²,

Akamatsu³

et al. 2014

WJH

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Section: Concerns On Lt For Acute Alcoholic Hepatitis Without An Abstsupporting

confidence: 81%

Section: Concerns On Lt For Acute Alcoholic Hepatitis Without An Abstmentioning

confidence: 99%

Perceptions of post-transplant recidivism in liver transplantation for alcoholic liver disease

Kawaguchi¹,

Sugawara²,

Akamatsu³

et al. 2014

WJH

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“…Three patients resumed drinking alcohol (at 720, 740, and 1140 days) after transplantation. 18 Singal et al reviewed the United Network for Organ Sharing database from 2004 to 2010 and found 130 patients who had alcoholic hepatitis and had been ''listed'' for transplantation, of whom 59 received a transplant, 40 11 had histologic appearances of alcoholic hepatitis on explant pathology, 33 had cirrhosis, and the remainder had other diagnoses. The graft and patient survivals were similar in the alcoholic hepatitis cohort compared to a control cohort of nonalcoholic recipients, which was selected by sequential matching according to gender, ethnicity, year of transplant, age (AE5 years), donor risk index, and MELD score (AE5 points).…”

Section: Liver Transplant For Alcoholic Hepatitismentioning

confidence: 99%

“…The graft and patient survivals were similar in the alcoholic hepatitis cohort compared to a control cohort of nonalcoholic recipients, which was selected by sequential matching according to gender, ethnicity, year of transplant, age (AE5 years), donor risk index, and MELD score (AE5 points). 40 Wells et al 41 retrospectively reviewed the explanted livers of 148 patients transplanted for ALD alone, drawn from a single-center cohort of 1097 patients transplanted over a period of 18 years. The histological features of alcoholic hepatitis were found in 32 (22%) patients.…”

Section: Liver Transplant For Alcoholic Hepatitismentioning

confidence: 99%

Liver Transplantation for Alcohol-Related Liver Disease

Choudhary

Kumar

Saigal

et al. 2016

Journal of Clinical and Experimental Hepatology

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Alcoholic liver disease (ALD) is a common indication for liver transplantation. It is a much debated indication for deceased donor liver transplantation due to organ shortage and potential of alcohol relapse after liver transplantation. A six-month abstinence before liver transplantation is required at most centers to decrease chances of alcohol relapse after liver transplantation. However, this rule is not relevant for patients with severe alcoholic hepatitis or severely decompensated patients who are unlikely to survive till 6 months. Long-term care of these patients after liver transplantation includes assessment of relapse, smoking, and surveillance of de novo malignancies. Current review discusses role of abstinence, factors affecting alcohol relapse, liver transplantation for alcoholic hepatitis, role of living donor liver transplantation, and long-term care of ALD patients who undergo liver transplantation. ( J CLIN EXP HEPATOL 2016;6:47-53) A lcoholic liver disease (ALD) is common indication for liver transplantation worldwide, 1,2 and is a common cause of decompensated cirrhosis and acute-on-chronic liver failure in India as well. 3,4 ALD has good outcome after liver transplantation that is comparable or better than other etiologies of liver transplantation. Recent European liver transplant registry data showed 73% 5-year and a 59% 10-year survival rate for ALD. 2 However, survival is lower in recipients who relapse to harmful pattern of drinking as noted in a systemic review of 13 studies by Rustad et al. 5 Liver transplantation for ALD leads to improvement in quality of life and employment rates. 6,7 During selection of these patients for liver transplantation, it is important to identify other alcohol-related problems like cardiomyopathy, chronic pancreatitis, skeletal muscle wasting, and neurotoxicities that may preclude or impair outcome of liver transplantation. 8 Patients who have lack of social support, are active smokers, and have psychiatric disorders or alcohol dependence should be listed only with reservations. 9 Smoking worsens the outcome of alcohol-related liver disease 10 and active smoking at the time of liver transplantation has been shown to be associated with post-transplant recidivism also. 11 PREDICTORS OF RELAPSEWhile liver transplantation improves functions of liver and cures complications of portal hypertension, it does not affect alcoholism and recipients may relapse again, sometimes to harmful levels of drinking, and pretransplant sobriety does not confirm sobriety after liver transplant. [12][13][14] Relapse may be in the form of occasional slips or harmful drinking pattern for a prolonged period; the later affects graft and patient survival. 5,11 Initially, 6-month abstinence was considered as a requirement before allocating organ to patients with ALD; however, it was based on poor quality small data. 15 The 6-month rule serves 2 purposes; it provides patient time to demonstrate a certain period of abstinence and patient may recover on medical management, and thus preempt...

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“…However, these data need confirmation in larger prospective studies before implementing this into routine clinical practice. 18,19 Alcohol-related liver disease remains an important public health problem. The World Health Organization's goal is to reduce the mortality rate from alcoholic cirrhosis to below 3.2 per 100,000 population by the year 2020, yet we are far away from this number.…”

mentioning

confidence: 99%

Recent trends in the epidemiology of alcoholic liver disease

Singal¹,

Anand²

2013

Clinical Liver Disease

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Alcohol has been the most frequently abused drug for centuries, but it was not until the 1960s that it was recognized as a direct hepatotoxin. 1 Chronic excessive use of alcohol can lead to fatty liver, alcoholic hepatitis, alcoholic cirrhosis, and liver cancer. Whereas fatty liver is a reversible process upon cessation of drinking alcohol, other pathologies are usually progressive despite abstinence. In the United States, approximately 60% of people in the general population report some drinking of alcohol with approximately 8% to 10% reporting heavy drinking (two or more drinks per day) where one drink is equivalent to 12 ounces of beer (4%-5% wt/vol), 6 ounces of wine (8%-10% wt/vol), and 2 ounces of hard liquor or whiskey (45% wt/vol). 2 Alcohol remains the second most common cause of liver cirrhosis after hepatitis C virus (HCV) infection in the United States, contributing to approximately 20% to 25% cases of liver cirrhosis and about half of all admissions among patients with cirrhosis. Of the various factors responsible for liver disease, duration and amount of drinking alcohol is the most important factor. Pooled data from many epidemiological studies show a minimum intake of 30 g/day of alcohol in women and 50 g/day in men consumed over at least 5 years to cause liver cirrhosis. 3 Prevalence and mortality rates from cirrhosis parallel alcohol consumption prevalence rates in the population globally. Within Europe, which has the highest rate of consumption per capita in the implementation of policies on alcohol sale has resulted in changing epidemiology in different parts of Europe. Alcohol consumption rates have decreased in southern Europe, whereas they have increased in eastern Europe and some areas of northern Europe (including Ireland and the United Kingdom). 4 Because only 10% to 15% of people engaged in heavy drinking develop liver cirrhosis, other factors such as host factors and comorbidities are clearly important (Fig. 1). Women are more prone to the hepatotoxic effect of alcohol compared with men and are prone to develop liver cirrhosis at a lower amount of alcohol consumption. Type of alcohol consumed, binge drinking (five or more drinks at one time), drinking on an empty stomach, and participation in alcohol rehabilitation programs such as Alcoholic Anonymous are some of the other factors. Alcohol use and concomitant HCV infection act synergistically to cause more frequent and faster progression of fibrosis. 5 With the epidemic of obesity in the United States, prevalence rates of metabolic syndrome and visceral adiposity are increasing among alcoholics contributing to more prevalent and severe liver disease. 6 Alcohol remains the third most common preventable cause of death after smoking and hypertension. Alcohol-related mortality affects young and middle-aged population with loss of productive life years. Liver-related mortality from alcohol contributes to 4% of mortality and 5% of disability adjusted life years (DALY) globally, with highest impact in Europe, where these same figures are 7% ...

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Outcomes after liver transplantation for alcoholic hepatitis are similar to alcoholic cirrhosis: Exploratory analysis from the UNOS database

Cited by 161 publications

References 25 publications

Perceptions of post-transplant recidivism in liver transplantation for alcoholic liver disease

Perceptions of post-transplant recidivism in liver transplantation for alcoholic liver disease

Liver Transplantation for Alcohol-Related Liver Disease

Recent trends in the epidemiology of alcoholic liver disease

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