Wells Jennifer T, Said Adnan, Agni Rashmi, Tome Santiago, Hughes Sarah, Dureja Parul, Lucey Michael R
Section of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53711, USA.
Liver Transpl. 2007 Dec;13(12):1728-35. doi: 10.1002/lt.21298.
Patients with clinical acute alcoholic hepatitis (AAH) are not considered suitable candidates for orthotopic liver transplantation (OLT). The histological correlates of AAH are often seen in the explanted liver at the time of transplantation. The importance of these findings remains inconclusive regarding their role as a prognostic marker for patient or allograft health. Our aim was to examine the explanted liver of patients with purely alcoholic liver disease (ALD) for findings of histologic AAH and to correlate these to patient and graft outcomes. We compared patients with and without histological AAH with patients transplanted for non-ALD. Of 1,097 liver transplant recipients, 148 had ALD and 125 were non-ALD control patients with similar demographics. Thirty-two of 148 ALD patients had histologic AAH, and 116 had bland alcoholic cirrhosis (BAC). Twenty-eight percent of the ALD patients reported <6 months abstinence, and 54% reported <12 months abstinence. There was a statistically significant relationship between the presence of histologic AAH and abstinence durations<12 months (P=0.009), but not <6 months. Overall, posttransplantation patient and graft survival between the ALD and non-ALD groups was not significantly different (P=0.53). Furthermore, patient and graft survival between ALD patients with histologic AAH and BAC were similar (P=0.13 and P=0.11, respectively). The rate of posttransplantation relapse among ALD patients was 16%; however, there was no increase in graft loss, nor was there decreased survival compared with controls. The patients with histologic AAH and those with BAC had no differences in posttransplantation relapse (P=0.13). In multivariate analysis, patient and graft survival was not influenced by pretransplantation abstinence or posttransplantation relapse. In conclusion, histological alcoholic hepatitis in the explant did not predict worse outcome regarding relapse, and allograft or patient survival for liver transplant recipients. Caution should be exercised when liver histology is used to discriminate among suitable candidates for OLT concerning alcoholic patients.
临床急性酒精性肝炎（AAH）患者不被视为原位肝移植（OLT）的合适候选者。AAH的组织学相关表现常在移植时的切除肝脏中见到。这些发现作为患者或移植物健康的预后标志物，其重要性仍无定论。我们的目的是检查纯酒精性肝病（ALD）患者的切除肝脏，以寻找组织学AAH的表现，并将这些表现与患者及移植物的预后相关联。我们将有或无组织学AAH的患者与因非ALD接受移植的患者进行了比较。在1097例肝移植受者中，148例患有ALD，125例为非ALD对照患者，两组人口统计学特征相似。148例ALD患者中，32例有组织学AAH，116例有单纯酒精性肝硬化（BAC）。28%的ALD患者报告戒酒时间<6个月，54%的患者报告戒酒时间<12个月。组织学AAH的存在与戒酒时间<12个月之间存在统计学显著关系（P=0.009），但与戒酒时间<6个月无关。总体而言，ALD组和非ALD组移植后患者及移植物存活率无显著差异（P=0.53）。此外，有组织学AAH的ALD患者和BAC患者的患者及移植物存活率相似（分别为P=0.13和P=0.11）。ALD患者移植后复发率为16%；然而，与对照组相比，移植物丢失率没有增加，存活率也没有降低。有组织学AAH的患者和BAC患者在移植后复发方面没有差异（P=0.13）。在多变量分析中，患者及移植物存活率不受移植前戒酒或移植后复发的影响。总之，切除肝脏中的组织学酒精性肝炎在复发、移植物或患者存活率方面并未预示更差的结果。在使用肝脏组织学来区分酒精性患者OLT的合适候选者时应谨慎。
