Early Liver Transplantation for Severe Alcoholic Hepatitis

Mathurin, Philippe; Moreno, Christophe; Samuel, Didier; Dumortier, Jérôme; Salleron, Julia; Durand, François; Castel, Hélène; Duhamel, Alain; Pageaux, Georges‐Philippe; Leroy, Vincent; Dharancy, Sébastien; Louvet, Alexandre; Boleslawski, Emmanuel; Lucidi, Valério; Gustot, Thierry; Francoz, Claire; Létoublon, Christian; Castaing, Denis; Belghiti, Jacques; Donckier, Vincent; Pruvot, François‐René; Duclos‐Vallée, Jean‐Charles

doi:10.1056/nejmoa1105703

Cited by 785 publications

(800 citation statements)

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“…17 Mathurin et al showed a cumulative 6-month survival rate of 77 AE 8% in patients with severe nonresponding alcoholic hepatitis who had early liver transplant versus 23 AE 8% for controls, P < 0.001. 18 Prevalence of alcohol relapse after liver transplantation varies widely. [19][20][21] This wide range of relapse after liver transplantation reflects several methodological differences among studies, variable follow-up, and difference in definition of relapse (any alcohol intake versus harmful drinking).…”

Section: Predictors Of Relapsementioning

confidence: 99%

“…In 2005, therapeutic trials of liver transplantation in patients with severe acute alcoholic hepatitis who have failed to respond to medical treatment were advocated by a French Consensus Conference, regardless of the period of their abstinence. 39 Mathurin et al 18 conducted a case-control study of early transplantation in a highly selective group of patients with severe alcoholic hepatitis who had failed to respond to medical therapy. Selected patients also had supportive family members, no severe coexisting conditions, and a commitment to alcohol abstinence.…”

Section: Liver Transplant For Alcoholic Hepatitismentioning

confidence: 99%

“…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%

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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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Section: Predictors Of Relapsementioning

confidence: 99%

Section: Liver Transplant For Alcoholic Hepatitismentioning

confidence: 99%

Section: Liver Transplant For Alcoholic Hepatitismentioning

confidence: 99%

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Liver Transplantation for Alcohol-Related Liver Disease

Choudhary

Kumar

Saigal

et al. 2016

Journal of Clinical and Experimental Hepatology

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“…In its severe form, AH can result in 20-50 % mortality at 3 months. The only available therapies that improve survival are corticosteroids and liver transplantation [5,6]. The efficacy of pentoxifylline is debatable, based on recent large clinical trials [6].…”

mentioning

confidence: 99%

Alcoholic hepatitis: should we combine old drugs for better results?

Cabezas

Bataller

2016

Hepatol Int

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Alcoholic liver disease (ALD) is the main cause of cirrhosis worldwide [1]. Despite its high prevalence, ALD has received little attention in the liver community and there is a clear lack of programs for early detection and novel targeted therapies for advanced forms. ALD encloses a wide spectrum of features, ranging from simple steatosis, steatohepatitis, and cirrhosis to hepatocellular carcinoma [2]. Patients with underlying ALD and heavy alcohol intake can develop an episode of alcoholic hepatitis (AH), the most severe form of ALD [3]. AH is characterized by an abrupt onset of jaundice and/or liver decompensation. Patients with AH often show signs of systemic inflammation at admission, and are prone to infections and kidney injury, which can lead to multi-organ dysfunction within a few days [4]. In its severe form, AH can result in 20-50 % mortality at 3 months. The only available therapies that improve survival are corticosteroids and liver transplantation [5,6]. The efficacy of pentoxifylline is debatable, based on recent large clinical trials [6]. The efficacy of prednisolone has been shown in meta-analyses of individual data and was partially confirmed in the recent STOPAH trial [6,7]. Unfortunately, many patients do not respond to prednisolone and performing salvage liver transplantation is not feasible in most centers. Therefore, there is an urgent need to provide these patients with novel targeted therapies. In the last two decades, there have been several attempts to test old and novel drugs in patients with severe AH, ranging from classic drugs [8] to monoclonal antibodies [9] or stimulating factors [10]

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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.…”

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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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Early Liver Transplantation for Severe Alcoholic Hepatitis

Abstract: Early liver transplantation can improve survival in patients with a first episode of severe alcoholic hepatitis not responding to medical therapy. (Funded by Société Nationale Française de Gastroentérologie.).

Cited by 785 publications

References 35 publications

Liver Transplantation for Alcohol-Related Liver Disease

Liver Transplantation for Alcohol-Related Liver Disease

Alcoholic hepatitis: should we combine old drugs for better results?

Recent trends in the epidemiology of alcoholic liver disease

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