Erard-Poinsot Domitille, Guillaud Olivier, Hervieu Valérie, Thimonier Elsa, Vallin Mélanie, Chambon-Augoyard Christine, Boillot Olivier, Scoazec Jean-Yves, Dumortier Jérôme
Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.
Service d'Anatomie et Cytologie Pathologiques, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.
Liver Transpl. 2016 Jun;22(6):773-84. doi: 10.1002/lt.24425.
Alcoholic liver disease (ALD) is a major indication for liver transplantation (LT), but up to 20% of patients experience severe alcoholic relapse. The aims of this study were to evaluate the impact of severe alcoholic relapse on the graft (based on histological examination) and to identify predictive factors associated with recurrent alcoholic cirrhosis (RAC). From 1990 to 2010, 369 patients underwent LT for ALD at Edouard Herriot Hospital (Lyon, France) and survived more than 1 year. All patients who presented severe alcoholic relapse and histological follow-up were included. Liver biopsies were performed at 1 and 5 years and at every 5 years after LT, and when clinically indicated. The median follow-up after LT was 11 years (range, 3-18 years). Severe alcoholic relapse was observed in 73 (20%) of the 369 patients, from whom 56 patients with histological evaluation were included. RAC was diagnosed in 18 (32%) of the 56 patients included, which represents 5% of the 369 patients transplanted for ALD. The median delay between LT and RAC was 6 years (range, 3-10 years) and 4.5 years (range, 2-8 years) after severe alcoholic relapse. The median cumulated years of alcohol use before RAC was 3.5 years (range, 2-7 years). The cumulative risk for F4 fibrosis was 15% at 3 years, 32% at 5 years, and 54% at 10 years after severe alcoholic relapse. A young age at LT (≤50 years old) and an early onset of heavy drinking (within the first 3 years after LT) were associated with RAC. In conclusion, severe alcoholic relapse usually occurs in the first years after LT and is responsible for accelerated severe graft injury. Liver Transplantation 22 773-784 2016 AASLD.
酒精性肝病（ALD）是肝移植（LT）的主要适应证，但高达20%的患者会出现严重的酒精复饮。本研究的目的是评估严重酒精复饮对移植物的影响（基于组织学检查），并确定与复发性酒精性肝硬化（RAC）相关的预测因素。1990年至2010年，369例患者在法国里昂爱德华·赫里奥特医院因ALD接受LT并存活超过1年。纳入所有出现严重酒精复饮并接受组织学随访的患者。LT后1年、5年以及之后每5年，在临床指征明确时进行肝活检。LT后的中位随访时间为11年（范围3 - 18年）。369例患者中有73例（20%）出现严重酒精复饮，其中56例患者接受了组织学评估。纳入的56例患者中有18例（32%）被诊断为RAC，占因ALD接受移植的369例患者的5%。LT至RAC的中位间隔时间为6年（范围3 - 10年），严重酒精复饮后为4.5年（范围2 - 8年）。RAC前酒精使用的中位累积年限为3.5年（范围2 - 7年）。严重酒精复饮后3年F4纤维化的累积风险为15%，5年为32%，10年为54%。LT时年龄较轻（≤50岁）以及大量饮酒起始较早（LT后前3年内）与RAC相关。总之，严重酒精复饮通常发生在LT后的最初几年，并导致移植物严重损伤加速。《肝脏移植》2016年第22卷773 - 784页，美国肝脏病研究协会
