Early Liver Transplantation in Acute Alcoholic Hepatitis

AbstractAlcohol-related liver disease (ALD) is currently the leading indication for liver transplantation in the United States. Among patients with ALD, those with acute alcoholic hepatitis who do not respond to medical treatment have a 6-month mortality of 70% without transplantation. Despite the high mortality, the majority of patients will not be eligible for transplant, given that most centers follow the 6-month abstinence rule. A handful of centers in Europe and the United States perform early liver transplantation (< 6 months abstinence) in these patients, as it provides a substantial survival benefit. Short-term outcomes for these recipients are favorable, and relapse rates parallel those seen in alcoholic cirrhosis transplant recipients who have completed the 6-month wait period. Moving forward, studies examining long-term outcomes and candidate selection are necessary for this growing subset of liver transplant candidates.

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Liver Transplantation for Alcoholic Hepatitis: Standard of Care Yet?

Digestive Disease Interventions ◽

10.1055/s-0040-1708532 ◽

2020 ◽

Vol 04 (01) ◽

pp. 036-039

Author(s):

Alejandro Cracco ◽

Lisandro Montorfano ◽

Jason M. Vanatta

Keyword(s):

Liver Transplantation ◽

Alcoholic Hepatitis ◽

Alcoholic Cirrhosis ◽

Standard Of Care ◽

Screening Tools ◽

Severe Alcoholic Hepatitis ◽

Patients At Risk ◽

Small Pool ◽

Related Liver Disease

AbstractAlcohol-related liver disease (ALD) is one of the most common indications for liver transplantation. However, liver transplantation for alcoholic hepatitis (AH) remains controversial. The morbidity of severe alcoholic hepatitis (SAH) is extremely high, with most of the deaths occurring within the first 2 months. Multiple studies have recently demonstrated significant improvement in overall survival following liver transplantation in patients with SAH who failed medical management, with comparable rates to those transplanted electively. Concerns remain due to the small pool of donors and the high risk of alcohol relapse in this population. The traditional requirement of 6 months of abstinence prior to transplantation, or also known as “6-month rule” is controversial and has been criticized as whether it is a good predictor of long-term sobriety. Previous studies among patients with alcoholic cirrhosis have indicated that this rule poorly identifies patients who will relapse after liver transplantation. More recent studies in patients transplanted for SAH, have reported relapse rates that are comparable to those with abstinence periods >6 months. Applying stringent selection criteria appears to be key in identifying patients who are less likely to relapse after transplantation, and therefore prolonging patient and graft life. However, further research is needed to identify patients at risk and create appropriate screening tools. In this article, we present a review of currently available data on this topic.

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