Six month abstinence rule for liver transplantation in severe alcoholic liver disease patients

Obed, Aiman; Stern, Steffen; Jarrad, Anwar; Lorf, Thomas

doi:10.3748/wjg.v21.i14.4423

Cited by 27 publications

(23 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Nonetheless, the data from this study suggest that in patients with severe ACLF and renal dysfunction, high‐performance albumin dialysis coupled with RRT may serve as a bridge therapy in patients listed for LT. It may also gain time in alcoholics, who are required to abstain from alcohol for a defined period of time before they can be listed for transplantation …”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Intermittent high‐flux albumin dialysis with continuous venovenous hemodialysis for acute‐on‐chronic liver failure and acute kidney injury

et al. 2019

View full text Add to dashboard Cite

Acute‐on‐chronic liver failure (ACLF) requiring intensive medical care and associated with acute kidney injury (AKI) has a mortality rate as high as 90% due to the lack of effective therapies. In this study, we assessed the effects of intermittent high‐flux single‐pass albumin dialysis (SPAD) coupled with continuous venovenous hemodialysis (CVVHD) on 28‐day and 90‐day survival and an array of clinical and laboratory parameters in patients with severe ACLF and renal insufficiency. Sixteen patients were studied. The diagnosis of ACLF and AKI was made in accordance with current EASL Clinical Practice Guidelines, including the recommendations of the International Club of Ascites. All patients received SPAD/CVVHD treatments as the blood purification therapy to support liver, kidneys, and other organs. Five patients were transplanted and 11 were not listed for transplantation because of active alcoholism. Data at the initiation of SPAD/CVVHD were compared with early morning data after the termination of the extracorporeal treatment phase. All patients had ACLF and renal insufficiency with 13/16 additionally fulfilling the AKI criteria. A total of 37 SPAD/CVVHD treatments were performed [2.3 ± 1.4]. The baseline MELD‐Na score was 37.6 ± 6.6 and decreased to 33.4 ± 8.7 after SPAD/CVVHD (P < 0.001). In parallel, the CLIF‐C ACLF grade and OF score, estimated at 28‐ and 90‐day mortality, AKI stage, hepatic encephalopathy grade, and liver function tests were lowered (P = 0.001–0.032). The 28‐ and 90‐day survivals were 56.2% overall and 53.8% in AKI. Survival in patients not transplanted (n = 11) was 45.4%. In patients with severe ACLF and AKI, the renal replacement therapy coupled with high‐performance albumin dialysis improved estimated 28‐ and 90‐day survival and several key clinical and laboratory parameters. It is postulated that these results may be further improved with earlier intervention and more SPAD treatments per patient. High‐performance albumin dialysis improves survival and key clinical and laboratory parameters in severe ACLF and AKI.

show abstract

Section: Discussionmentioning

confidence: 99%

“…It may also gain time in alcoholics, who are required to abstain from alcohol for a defined period of time before they can be listed for transplantation. 36…”

Section: Discussionmentioning

confidence: 99%

Intermittent high‐flux albumin dialysis with continuous venovenous hemodialysis for acute‐on‐chronic liver failure and acute kidney injury

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Medical law experts are repeatedly reminded, albeit from a different point of view than those associated with medical practice, that US constitutional law prohibits discrimination against subgroups and differentiating individuals as being either worthy or unworthy of life. The exclusion of non-sober ALD patients from LT waiting lists discriminates against them and violates this United States constitutional law[ 44 ].…”

Section: Historical Perspective Controversies and Considerationsmentioning

confidence: 99%

Liver transplantation and alcoholic liver disease: History, controversies, and considerations

Ca¹,

Am²,

Sa³

et al. 2018

WJG

121

View full text Add to dashboard Cite

Alcohol consumption accounts for 3.8% of annual global mortality worldwide, and the majority of these deaths are due to alcoholic liver disease (ALD), mainly alcoholic cirrhosis. ALD is one of the most common indications for liver transplantation (LT). However, it remains a complicated topic on both medical and ethical grounds, as it is seen by many as a “self-inflicted disease”. One of the strongest ethical arguments against LT for ALD is the probability of relapse. However, ALD remains a common indication for LT worldwide. For a patient to be placed on an LT waiting list, 6 mo of abstinence must have been achieved for most LT centers. However, this “6-mo rule” is an arbitrary threshold and has never been shown to affect survival, sobriety, or other outcomes. Recent studies have shown similar survival rates among individuals who undergo LT for ALD and those who undergo LT for other chronic causes of end-stage liver disease. There are specific factors that should be addressed when evaluating LT patients with ALD because these patients commonly have a high prevalence of multisystem alcohol-related changes. Risk factors for relapse include the presence of anxiety or depressive disorders, short pre-LT duration of sobriety, and lack of social support. Identification of risk factors and strengthening of the social support system may decrease relapse among these patients. Family counseling for LT candidates is highly encouraged to prevent alcohol consumption relapse. Relapse has been associated with unique histopathological changes, graft damage, graft loss, and even decreased survival in some studies. Research has demonstrated the importance of a multidisciplinary evaluation of LT candidates. Complete abstinence should be attempted to overcome addiction issues and to allow spontaneous liver recovery. Abstinence is the cornerstone of ALD therapy. Psychotherapies, including 12-step facilitation therapy, cognitive-behavioral therapy, and motivational enhancement therapy, help support abstinence. Nutritional therapy helps to reverse muscle wasting, weight loss, vitamin deficiencies, and trace element deficiencies associated with ALD. For muscular recovery, supervised physical activity has been shown to lead to a gain in muscle mass and improvement of functional activity. Early LT for acute alcoholic hepatitis has been the subject of recent clinical studies, with encouraging results in highly selected patients. The survival rates after LT for ALD are comparable to those of patients who underwent LT for other indications. Patients that undergo LT for ALD and survive over 5 years have a higher risk of cardiorespiratory disease, cerebrovascular events, and de novo malignancy.

show abstract

“…Die zusätzliche Gabe von N-Acetylcystein kann auch hilfreich sein [10 -12]. Eine Anzahl weiterer Medikamente, einschließlich des TNF-α-Antikörpers Infliximab [53] [76], was die 6-Monats-Regel weiter infrage stellt [77].…”

Section: Therapie Der Alkoholischen Hepatitis (Ah)unclassified

Etablierte Therapien und neue therapeutische Ansätze bei der alkoholischen Leberkrankung

Seitz¹,

Mueller²

2016

Z Gastroenterol

View full text Add to dashboard Cite

Chronical alcohol abuse causes more than 200 diseases and/or symptoms and among these alcoholic liver disease (ALD) is of special importance since it occurs frequently and may be life-threatening. In Europe alcohol consumption as well as ALD increased as compared to the rest of the world. It has been estimated that in Europe approximately 500 000 people die every year due to ALD. ALD consists of alcoholic fatty liver, alcoholic steatohepatitis (ASH), alcoholic cirrhosis and hepatocellar cancer (HCC ). Alcohol hepatitis (AH) is a clinical feature with jaundice and liver failure and a high mortality. The course of ALD is variable and depends among others, on genetics, gender, the presence of other liver diseases as well as exposure towards toxic substances and drugs. The treatment of ALD mainly consists of alcohol abstinence which may be difficult to achieve in the alcoholic. The results of the therapy improve by cognitive psychotherapy as well as antigraving medication. The treatment of AH with poor prognosis is limited. Although a number of therapeutic approaches in AH have been tried, the present therapy consists of intensive care in association with the administration of steroids, hyperalimentation and possibly the administration of N-acetylcystein. Presently it is discussed whether liver transplantation is an option for these patients. New therapeutic approaches focuses on pathopyhsiologically identified targets in ALD. This includes elimination of endotoxines, cytokines, and chemokines as well as an inhibition oxidative stress. Antigraving substances, such as Nalmafen also may improve liver function since their administration degreases alcohol consumption. In addition, betain to stimulate methyltransfer as well the inhibition of apoptosis have been investigated. Stimulation of liver regeneration by granulozytecolony stimulating factor as well as mesenchymalcell and bone marrow transplantation have shown some positive results. Nevertheless new therapeutic strategies are urgently needed. Especially in AH with its high mortality.

show abstract

Six month abstinence rule for liver transplantation in severe alcoholic liver disease patients

Cited by 27 publications

References 36 publications

Intermittent high‐flux albumin dialysis with continuous venovenous hemodialysis for acute‐on‐chronic liver failure and acute kidney injury

Intermittent high‐flux albumin dialysis with continuous venovenous hemodialysis for acute‐on‐chronic liver failure and acute kidney injury

Liver transplantation and alcoholic liver disease: History, controversies, and considerations

Etablierte Therapien und neue therapeutische Ansätze bei der alkoholischen Leberkrankung

Contact Info

Product

Resources

About