The place of liver transplantation in the treatment of severe alcoholic hepatitis

Abstract

Although most patients with alcoholic liver disease experience positive outcomes following liver transplantation, data on the outcome after liver transplantation in patients with severe alcoholic hepatitis are limited. Furthermore, predicting which patients with severe alcoholic hepatitis will maintain sobriety after transplantation is especially difficult. We review the arguments in favour and against extending liver transplantation to selected patients with severe alcoholic hepatitis. In conclusion, we propose that liver transplantation should be a rescue option for occasional patients with severe alcoholic hepatitis who meet the following criteria: those with severe alcoholic hepatitis that has failed medical management, who fulfil all other standard criteria for transplantation, including a thorough psychosocial assessment, yet who are unlikely to survive a mandatory 6-month abstinence period.

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

“…Alcoholic hepatitis is a distinct clinical syndrome associated with recent or ongoing alcohol consumption, and its severity leads to high mortality exceeding 50% [35,[43][44][45][46] . Medical treatment including the use of corticosteroids and/or pentoxifylline reduces the mortality rate to approximately 20%-30% [43,47] .…”

The Role of Liver Transplantation in theTreatment of Alcoholic Liver Disease

“…Patients with a previously normal liver present an opportunity, from a technical standpoint, as the www.intechopen.com liver transplantation is significantly easier with the absence of the trademarks of end-stage liver disease, such as portal hypertension (Figure 1 a, b). Unfortunately, in the severe form, even with maximal medical treatment, there is a 40-50% mortality within 1 month after diagnosis (Dureja & Lucey, 2010). This very high mortality, despite the organ shortage, has led to many advocating LT for that subset of patients who have failed medical treatment.…”

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

“…The same "6 mo rule" is being applied currently in transplant centers, including in the United States, for patients with AH [11,12] . Patients with severe AH who do not respond to corticosteroids or pentoxifylline have a mortality of 50%-75% at 6 mo [12] . Hence, this rule of 6 mo abstinence cannot be applied if these patients are to be better managed and salvaged.…”

“…Hence, this rule of 6 mo abstinence cannot be applied if these patients are to be better managed and salvaged. Clearly, there is an urgent need for changing this policy of abstinence of 6 mo [12] . Before we take this drastic action, let us examine critically what the effect of abstinence of 6 mo on the rate of alcohol relapse after LT (recidivism) has been.…”

“…However, we think that the time is right to reevaluate our policy [12] . Current data clearly show that LT is a definitive treatment option for the group of patients with severe AH who continue to deteriorate despite intensive medical treatment.…”