Early Liver Transplantation in Acute Alcoholic Hepatitis

Haugen, Christine E.; Cameron, Andrew M.

doi:10.1055/s-0039-3399560

Cited by 2 publications

(3 citation statements)

References 28 publications

(34 reference statements)

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“…Alcohol-related liver disease (ALD) is the most common indication of liver transplantation in Europe and the US [80]. Severe alcoholic hepatitis (SAH) is the presence of jaundice and hepatic decompensation in individuals who consume excessive alcohol [81].…”

Section: Severe Alcoholic Hepatitismentioning

confidence: 99%

“…The American Consortium of Early Liver Transplantation for Alcoholic Hepatitis (ACCELERATE-AH) group evaluated the results of early liver transplantation of 147 patients with SAH without waiting for 6 months of alcohol abstinence period in 12 transplantation centers and reported a 1-year survival rate of 94%, and 3-year survival rate of 84% (85). Data from Europe and the US confirm the need for reconsideration of the rule of 6 months of alcohol abstinence period [80].…”

Section: Severe Alcoholic Hepatitismentioning

confidence: 99%

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Update on liver transplantation-newer aspects

2020

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Liver transplantation (LT) remains the only therapeutic option offering gold standard treatment for end-stage liver disease (ESLD) and acute liver failure (ALF), as well as for certain early-stage liver tumors. Currently, the greatest challenge facing LT is the simple fact that there are not enough adequate livers for all the potential patients that could benefit from LT. Despite efforts to expand the donor pool to include living and deceased donors, organ shortage is still a major problem in many countries. To solve this problem, the use of marginal liver grafts has become an inevitable choice. Although the definition of marginal grafts or criteria for expanded donor selection has not been clarified yet, they are usually defined as grafts that may potentially cause primary nonfunction, impaired function, or late loss of function. These include steatotic livers, older donors, donors with positive viral serology, split livers, and donation after cardiac death (DCD). Therefore, to get the best outcome from these liver grafts, donor-recipient selection should be vigilant. Alcoholrelated liver disease (ALD) is one of the most common indications for LT in Europe and North America. Traditionally, LT for alcoholic liver disease was kept limited for patients who have achieved 6 months of abstinence, in part due to social and ethical concerns regarding the use of a limited resource. However, the majority of patients with severe alcoholic hepatitis who fail medical therapy will not live long enough to meet this requirement. Besides, the initial results of early liver transplantation (ELT) without waiting for 6 months of abstinence period are satisfactory in severe alcoholic hepatitis (SAH). It will be important to take care of these patients from a newer perspective.

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Section: Severe Alcoholic Hepatitismentioning

confidence: 99%

Section: Severe Alcoholic Hepatitismentioning

confidence: 99%

Update on liver transplantation-newer aspects

2020

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“…Corticosteroids administered to patients with severe AH increase the risk of developing serious infections and may increase the risk of mortality in patients who experience infection [ 8 ]. Patients with severe AH unresponsive to medical therapy have 1-year mortality rates of up to 70%–90% [ 9 , 10 ]. Early liver transplantation (LT) for severe AH is a potentially life-saving treatment with established survival benefits [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Outcome of patients with severe alcoholic hepatitis after Model for End-Stage Liver Disease-based allocation system implementation in Korea

Kwon

Kang

Gwak

et al. 2021

Korean Journal of Transplantation

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Background:The Model for End-Stage Liver Disease (MELD)-based allocation system was implemented in Korea in July 2016 without a mandatory abstinence period for liver transplantation (LT) listing. However, the impact of the allocation policy has not been evaluated in patients with severe alcoholic hepatitis (AH). Methods: A total of 81 consecutive patients with severe AH between January 2014 and December 2018 were analyzed. The clinical course of patients before and after the implementation of the MELD-based allocation system was assessed. Results: More patients received LT (25%-65%) after the MELD allocation system was implemented. The increase in patients receiving deceased donor LT was dramatic (17%-51%, P=0.001) compared to patients receiving living donor LT (7%-14%, P=0.30). The overall survival was better for those who received LT (88% vs. 44% at 1 year, P<0.001), and after the MELD era (1-year survival rate: 80% vs. 50%, P=0.005). Post-LT mortality was observed in six patients, with one case of mortality related to recidivism. Baseline MELD and steroid response were factors associated with transplant-free survival. Conclusions: After implementation of the MELD-based allocation system, deceased donor LT dramatically increased in patients with severe AH. This translated into increased overall survival, but at a cost of mortality due to recidivism. Urgent evaluation is warranted to identify criteria to justify the use of precious liver grafts from deceased donors for severe AH patients in Korea.

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Early Liver Transplantation in Acute Alcoholic Hepatitis

Cited by 2 publications

References 28 publications

Update on liver transplantation-newer aspects

Update on liver transplantation-newer aspects

Outcome of patients with severe alcoholic hepatitis after Model for End-Stage Liver Disease-based allocation system implementation in Korea

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