Recanati/Miller Transplantation Institute, Division of Liver Diseases, Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, NY.
Department of Psychiatry, The Icahn School of Medicine at Mount Sinai, New York, NY.
Am J Transplant. 2016 Mar;16(3):841-9. doi: 10.1111/ajt.13586. Epub 2015 Dec 28.
Early liver transplantation (LT) in European centers reportedly improved survival in patients with severe alcoholic hepatitis (AH) not responding to medical therapy. Our aim was to determine if a strategy of early LT for severe AH could be applied successfully in the United States. We reviewed 111 patients with severe AH at our center from January 2012 to January 2015. The primary end point was mortality at 6 months or early LT, with a secondary end point of alcohol relapse after LT. Survival was compared between those receiving early LT and matched patients who did not. Using a process similar to the European trial, 94 patients with severe AH not responding to medical therapy were evaluated for early LT. Overall, 9 (9.6%) candidates with favorable psychosocial profiles underwent early LT, comprising 3% of all adult LT during the study period. The 6-month survival rate was higher among those receiving early LT compared with matched controls (89% vs 11%, p<0.001). Eight recipients are alive at a median of 735 days with 1 alcohol relapse. Early LT for severe AH can achieve excellent clinical outcomes with low impact on the donor pool and low rates of alcohol relapse in highly selected patients in the United States.
据报道，欧洲中心的早期肝移植（LT）改善了对药物治疗无反应的严重酒精性肝炎（AH）患者的生存率。我们的目的是确定在美国是否可以成功应用早期 LT 治疗严重 AH 的策略。我们回顾了 2012 年 1 月至 2015 年 1 月在我们中心的 111 例严重 AH 患者。主要终点是 6 个月或早期 LT 的死亡率，次要终点是 LT 后酒精复发。接受早期 LT 和未接受早期 LT 的匹配患者的存活率进行了比较。采用类似于欧洲试验的方法，对 94 例对药物治疗无反应的严重 AH 患者进行了早期 LT 的评估。总的来说，9 名（9.6%）具有良好社会心理特征的候选者接受了早期 LT，占研究期间所有成人 LT 的 3%。与匹配对照组相比，接受早期 LT 的患者 6 个月生存率更高（89%比 11%，p<0.001）。8 名受者的中位存活时间为 735 天，1 名出现酒精复发。在美国，经过高度选择的患者中，早期 LT 治疗严重 AH 可获得极好的临床结果，对供体库的影响较小，酒精复发率较低。
