Meeting Report: The Dallas Consensus Conference on Liver Transplantation for Alcohol Associated Hepatitis

Asrani, Sumeet K.; Trotter, James F.; Lake, Jack; Ahmed, Aijaz; Bonagura, Anthony; Cameron, Andrew M.; DiMartini, Andrea F.; Gonzalez, Stevan A.; Im, Gene Y.; Martin, Paul L.; Maury, Philippe; Mellinger, Jessica L.; Rice, John P.; Shah, Vijay H.; Terrault, Norah A.; Wall, Anji; Winder, Scott; Klintmalm, Göran B.

doi:10.1002/lt.25681

Cited by 83 publications

(108 citation statements)

References 55 publications

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“…Our study provides some important considerations in the effort to standardize the patient selection process. It is clear that a gap exists between recommendations of professional societies' and individual transplant center's approach to AH LT 2,25,36 . The higher waitlist dropout rate for high MELD non‐AH patients when compared to similarly high MELD AH patients is intriguing.…”

Section: Discussionmentioning

confidence: 99%

Liver transplantation for alcoholic hepatitis in the United States: Excellent outcomes with profound temporal and geographic variation in frequency

Cotter

Sandikçi

Paul

et al. 2021

American Journal of Transplantation

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Medical‐refractory severe alcoholic hepatitis (AH) has a high mortality. The national frequency, longer term outcomes and regional practices of AH liver transplantation (LT) in the United States are not well described, despite the increasing mortality from alcohol‐associated liver disease. We analyzed the trends in frequency and outcomes of UNOS data on 39 455 adult patients who underwent LT from 2014 to 2019, including AH LT recipients. LTs for AH increased 5‐fold, from 28 in 2014 to 138 in 2019, varying 8‐fold between UNOS regions. Three transplant centers accounted for 50%‐90% of AH LTs within each region. The number of transplant centers performing AH LTs increased from 14 in 2014 to 47 in 2019. AH patients were younger (mean = 39.4 years), had higher MELD scores (mean = 36.8), and were more often on dialysis (46.0%) and in ICU (38.4%), compared to other indications (all P < .05). One‐ and 5‐year graft survivals for AH LT recipients were 91.7% and 81.9%, respectively. The frequency of AH LT is increasing rapidly, with excellent medium‐term outcomes. An impact of AH recurrence on patient or graft survival is not apparent in this national analysis. There are marked geographic variations in practices, highlighting the lack of selection criteria standardization.

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Section: Discussionmentioning

confidence: 99%

Liver transplantation for alcoholic hepatitis in the United States: Excellent outcomes with profound temporal and geographic variation in frequency

Cotter

Sandikçi

Paul

et al. 2021

American Journal of Transplantation

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show abstract

“…The original MELD score uses bilirubin, creatinine, INR (a new derivation MELDNa incorporates serum sodium) as variables. A MELD score of over 20 defines severe AH with an approximate 20% mortality [25]. Some of the advantages of the MELD score over the DF are the use of INR as compared to prothrombin time, and the use of serum creatinine to include renal function, which plays an important role in the prognosis of AH patients [16].…”

Section: Model Of End-stage Liver Disease (Meld)mentioning

confidence: 99%

Emerging Noninvasive Biomarkers, and Medical Management Strategies for Alcoholic Hepatitis: Present Understanding and Scope

Gala

Vatsalya

2020

Cells

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Alcohol use disorder is associated with a wide array of hepatic pathologies ranging from steatosis to alcoholic-related cirrhosis (AC), alcoholic hepatitis (AH), or hepatocellular carcinoma (HCC). Biomarkers are categorized into two main categories: biomarkers associated with alcohol consumption and biomarkers of alcoholic liver disease (ALD). No ideal biomarker has been identified to quantify the degree of hepatocyte death or severity of AH, even though numerous biomarkers have been associated with AH. This review provides information of some of the novel and latest biomarkers that are being investigated and have shown a substantial association with the degree and severity of liver injury and inflammation. Importantly, they can be measured noninvasively. In this manuscript, we consolidate the present understanding and prospects of these biomarkers; and their application in assessing the severity and progression of the alcoholic liver disease (ALD). We also review current and upcoming management options for AH.

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“…The use of the "6-month rule" for alcohol abstinence has been widely criticized as an insufficient predictor for post-LT alcohol relapse. (6,7) An often-cited rationale for an abstinence period is to provide the opportunity for natural liver recovery that may ameliorate the need for LT. However, decision algorithms can include consideration of improving liver status, without mandating the completion of an abstinence period.…”

Section: The Internet As a Tool For Liver Transplant Programs To Combmentioning

confidence: 99%

The Internet as a Tool for Liver Transplant Programs to Combat Stigma Related to Alcohol Use Disorder

2021

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Meeting Report: The Dallas Consensus Conference on Liver Transplantation for Alcohol Associated Hepatitis

Abstract: This is the author manuscript accepted for publication and has undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as

Cited by 83 publications

References 55 publications

Liver transplantation for alcoholic hepatitis in the United States: Excellent outcomes with profound temporal and geographic variation in frequency

Liver transplantation for alcoholic hepatitis in the United States: Excellent outcomes with profound temporal and geographic variation in frequency

Emerging Noninvasive Biomarkers, and Medical Management Strategies for Alcoholic Hepatitis: Present Understanding and Scope

The Internet as a Tool for Liver Transplant Programs to Combat Stigma Related to Alcohol Use Disorder

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