Controversies in Early Liver Transplantation for Severe Alcoholic Hepatitis
Alcoholic hepatitis (AH) is a condition of acute liver inflammation in the setting of heavy alcohol use that is often managed with corticosteroids in severe cases. Among non-responders to steroids, however, prognosis is poor with up to 75% mortality within 6 months after treatment failure. Early liv...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2018-09-01
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| Series: | Annals of Hepatology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1665268119302534 |
| _version_ | 1830431829507702784 |
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| author | Tiffany Wu Timothy R. Morgan Andrew S. Klein Michael L. Volk Sammy Saab Vinay Sundaram |
| author_facet | Tiffany Wu Timothy R. Morgan Andrew S. Klein Michael L. Volk Sammy Saab Vinay Sundaram |
| author_sort | Tiffany Wu |
| collection | DOAJ |
| description | Alcoholic hepatitis (AH) is a condition of acute liver inflammation in the setting of heavy alcohol use that is often managed with corticosteroids in severe cases. Among non-responders to steroids, however, prognosis is poor with up to 75% mortality within 6 months after treatment failure. Early liver transplantation (LT) can achieve an acceptable short-term survival, and initial studies have demonstrated 3-year survival rates of up to 84%. However, the practice of early LT in severe AH remains controversial with concerns over the 6-month rule of sobriety and risk of alcohol relapse post-transplant. Proponents of LT advocate for better understanding of alcohol use as a disorder rather than self-inflicted cause of illness, aim to redefine the misguided application of the 6-month rule, and point out similar relapse rates among patients with early LT and those with greater than 6 months abstinence before transplant. Opponents of LT emphasize the correlation between alcohol relapse and graft failure and mortality, public resistance and potential for distrust among donors, and arguments that transplant centers need to establish improved models to predict relapse and standardize candidate selection criteria across centers. Here we review recent literature on this controversy and provide recommendations for moving forward to consensus. |
| first_indexed | 2024-12-21T02:13:24Z |
| format | Article |
| id | doaj.art-d3da4f9376074d45917f9a94ceed33e8 |
| institution | Directory Open Access Journal |
| issn | 1665-2681 |
| language | English |
| last_indexed | 2024-12-21T02:13:24Z |
| publishDate | 2018-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Annals of Hepatology |
| spelling | doaj.art-d3da4f9376074d45917f9a94ceed33e82022-12-21T19:19:18ZengElsevierAnnals of Hepatology1665-26812018-09-01175759768Controversies in Early Liver Transplantation for Severe Alcoholic HepatitisTiffany Wu0Timothy R. Morgan1Andrew S. Klein2Michael L. Volk3Sammy Saab4Vinay Sundaram5Department of Medicine, Division of Gastroenterology and Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, USADepartment of Veterans Affairs, VA Long Beach Healthcare System, Long Beach, CA, Division of Gastroenterology, University of California, Irvine, CA, USADepartment of Surgery and Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, USADivision of Gastroenterology and Transplantation Institute, Loma Linda University, Loma Linda, CA, USADivision of Digestive Diseases and Pfleger Liver Institute, University of California, Los Angeles, CA, USADepartment of Medicine, Division of Gastroenterology and Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Correspondence and reprint request:Alcoholic hepatitis (AH) is a condition of acute liver inflammation in the setting of heavy alcohol use that is often managed with corticosteroids in severe cases. Among non-responders to steroids, however, prognosis is poor with up to 75% mortality within 6 months after treatment failure. Early liver transplantation (LT) can achieve an acceptable short-term survival, and initial studies have demonstrated 3-year survival rates of up to 84%. However, the practice of early LT in severe AH remains controversial with concerns over the 6-month rule of sobriety and risk of alcohol relapse post-transplant. Proponents of LT advocate for better understanding of alcohol use as a disorder rather than self-inflicted cause of illness, aim to redefine the misguided application of the 6-month rule, and point out similar relapse rates among patients with early LT and those with greater than 6 months abstinence before transplant. Opponents of LT emphasize the correlation between alcohol relapse and graft failure and mortality, public resistance and potential for distrust among donors, and arguments that transplant centers need to establish improved models to predict relapse and standardize candidate selection criteria across centers. Here we review recent literature on this controversy and provide recommendations for moving forward to consensus.http://www.sciencedirect.com/science/article/pii/S1665268119302534Alcohol use disorderSix-month ruleOutcomesSteroidsEarly liver transplantation |
| spellingShingle | Tiffany Wu Timothy R. Morgan Andrew S. Klein Michael L. Volk Sammy Saab Vinay Sundaram Controversies in Early Liver Transplantation for Severe Alcoholic Hepatitis Annals of Hepatology Alcohol use disorder Six-month rule Outcomes Steroids Early liver transplantation |
| title | Controversies in Early Liver Transplantation for Severe Alcoholic Hepatitis |
| title_full | Controversies in Early Liver Transplantation for Severe Alcoholic Hepatitis |
| title_fullStr | Controversies in Early Liver Transplantation for Severe Alcoholic Hepatitis |
| title_full_unstemmed | Controversies in Early Liver Transplantation for Severe Alcoholic Hepatitis |
| title_short | Controversies in Early Liver Transplantation for Severe Alcoholic Hepatitis |
| title_sort | controversies in early liver transplantation for severe alcoholic hepatitis |
| topic | Alcohol use disorder Six-month rule Outcomes Steroids Early liver transplantation |
| url | http://www.sciencedirect.com/science/article/pii/S1665268119302534 |
| work_keys_str_mv | AT tiffanywu controversiesinearlylivertransplantationforseverealcoholichepatitis AT timothyrmorgan controversiesinearlylivertransplantationforseverealcoholichepatitis AT andrewsklein controversiesinearlylivertransplantationforseverealcoholichepatitis AT michaellvolk controversiesinearlylivertransplantationforseverealcoholichepatitis AT sammysaab controversiesinearlylivertransplantationforseverealcoholichepatitis AT vinaysundaram controversiesinearlylivertransplantationforseverealcoholichepatitis |