Berlakovich Gabriela A
Gabriela A Berlakovich, Department of Surgery, Division of Transplantation, Medical University of Vienna, Vienna, A-1090, Austria.
World J Gastroenterol. 2014 Jul 7;20(25):8033-9. doi: 10.3748/wjg.v20.i25.8033.
Transplantation for the treatment of alcoholic cirrhosis is more controversially discussed than it is for any other indication. The crucial aspect in this setting is abstinence before and after liver transplantation. We established pre-transplant selection criteria for potential transplant candidates. Provided that the underlying disease can be treated, there is no reason to withhold liver transplantation in a patient suffering from alcoholic cirrhosis. Evaluation of the patient by a multidisciplinary team, including an addiction specialist, is considered to be the gold standard. However, several centers demand a specified period of abstinence - usually 6 mo- irrespective of the specialist's assessment. The 6-mo rule is viewed critically because liver transplantation was found to clearly benefit selected patients with acute alcoholic hepatitis; the benefit was similar to that achieved for other acute indications. However, the discussion may well be an academic one because the waiting time for liver transplantation exceeds six months at the majority of centers. The actual challenge in liver transplantation for alcoholic cirrhosis may well be the need for lifelong post-transplant follow-up rather than the patient's pre-transplant evaluation. A small number of recipients experience a relapse of alcoholism; these patients are at risk for organ damage and graft-related death. Post-transplant surveillance protocols should demonstrate alcohol relapse at an early stage, thus permitting the initiation of adequate treatment. Patients with alcoholic cirrhosis are at high risk of developing head and neck, esophageal, or lung cancer. The higher risk of malignancies should be considered in the routine assessment of patients suffering from alcoholic cirrhosis. Tumor surveillance protocols for liver transplant recipients, currently being developed, should become a part of standard care; these will improve survival by permitting diagnosis at an early stage. In conclusion, the key factor determining the outcome of transplantation for alcoholic cirrhosis is intensive lifelong medical and psychological care. Post-transplant surveillance might be much more important than pre-transplant selection.
与其他适应证相比，酒精性肝硬化的移植治疗更具争议性。在此情况下，关键因素是肝移植前后的戒酒情况。我们制定了潜在移植受者的移植前选择标准。如果潜在疾病可以治疗，那么对于患有酒精性肝硬化的患者，就没有理由拒绝肝移植。由包括成瘾专家在内的多学科团队对患者进行评估被认为是金标准。然而，一些中心要求有特定的戒酒期——通常为6个月，而不考虑专家的评估。6个月规则受到批评，因为发现肝移植对选定的急性酒精性肝炎患者有明显益处；这种益处与其他急性适应证所取得的益处相似。然而，这场讨论很可能只是学术性的，因为大多数中心肝移植的等待时间超过6个月。酒精性肝硬化肝移植的实际挑战很可能是移植后需要终身随访，而不是患者的移植前评估。少数受者会出现酒精中毒复发；这些患者有器官损害和移植物相关死亡的风险。移植后监测方案应能在早期发现酒精复发，从而允许启动适当的治疗。酒精性肝硬化患者发生头颈、食管或肺癌的风险很高。在对酒精性肝硬化患者进行常规评估时，应考虑到较高的恶性肿瘤风险。目前正在制定的肝移植受者肿瘤监测方案应成为标准护理的一部分；这些方案将通过早期诊断提高生存率。总之，决定酒精性肝硬化移植结果的关键因素是终身强化的医疗和心理护理。移植后监测可能比移植前选择更为重要。
