Schneekloth Terry D, Niazi Shehzad K, Simonetto Douglas A
aDepartment of Psychiatry and Psychology bWilliam J. von Liebig Transplant Center cDepartment of Psychiatry and Psychology, Jacksonville, Florida dDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Curr Opin Organ Transplant. 2017 Dec;22(6):578-583. doi: 10.1097/MOT.0000000000000468.
The majority of liver transplantation centers have required patients with alcohol-induced liver disease to demonstrate a period of abstinence (generally 6 months' duration) to qualify for transplant listing. This requirement has excluded patients with alcoholic hepatitis from transplant consideration. Since 2011, several studies have examined the outcomes of patients undergoing liver transplantation with brief abstinence as a lifesaving intervention for alcoholic hepatitis. This review includes each of the recent studies and discusses their implications for general transplant practice.
A Medical Literature Analysis and Retrieval System search revealed five published studies - three prospective and two retrospective - pertaining to liver transplantation for alcoholic hepatitis. Among patients with medication-nonresponsive alcoholic hepatitis, those who underwent transplantation had superior survival. Liver recipients with alcoholic hepatitis had comparable survival to those with 6 or more months of abstinence. Their relapse rates were not statistically different in the short term over those transplanted with longer abstinence, although some patients in each prospective cohort relapsed to drinking despite narrow inclusion criteria and extensive pretransplant staff reviews and posttransplant surveillance.
Liver transplantation is a reasonable treatment consideration for highly selective cases of alcoholic hepatitis. Further research is needed to refine inclusion criteria, address posttransplant relapse prevention interventions, and monitor long-term outcomes.
大多数肝移植中心要求酒精性肝病患者证明有一段戒酒期（通常为6个月）才有资格列入移植名单。这一要求将酒精性肝炎患者排除在移植考虑范围之外。自2011年以来，多项研究探讨了对酒精性肝炎患者进行短期戒酒作为挽救生命的干预措施后进行肝移植的结果。本综述纳入了每一项近期研究，并讨论了它们对一般移植实践的意义。
医学文献分析与检索系统的搜索显示，有五项已发表的研究——三项前瞻性研究和两项回顾性研究——涉及酒精性肝炎的肝移植。在药物治疗无反应的酒精性肝炎患者中，接受移植的患者生存率更高。酒精性肝炎肝移植受者的生存率与戒酒6个月或更长时间的受者相当。短期内，他们的复发率与戒酒时间更长的移植受者相比无统计学差异，尽管每个前瞻性队列中的一些患者尽管纳入标准严格、移植前有大量工作人员评估和移植后监测，但仍复发饮酒。
对于高度选择性的酒精性肝炎病例，肝移植是一种合理的治疗选择。需要进一步研究以完善纳入标准、解决移植后预防复发的干预措施并监测长期结果。
