Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA.
Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA.
Transplantation. 2018 Mar;102(3):433-439. doi: 10.1097/TP.0000000000001969.
Alcoholic liver disease is a common indication for orthotopic liver transplantation (OLT). Although OLT has been shown to confer survival benefit to patients with acute alcoholic hepatitis (AAH), historically most programs require a 6-month abstinence period before OLT which excludes patients with AAH. Marijuana has become legal in more than half the states in the United States. This survey of liver transplant programs was conducted to evaluate current policies regarding alcohol, marijuana and methadone use.
A questionnaire was distributed to 100 United Network for Organ Sharing-approved liver transplant programs in North America that have performed at least 30 liver transplants/year in the last 5 years.
Forty-nine programs responded. Only 43% of the programs required a specific period of abstinence before transplant for alcoholic liver disease and only 26% enforced 6-month abstinence policy. For patients with AAH, 71% programs waived the 6-month abstinence requirement and considered psychosocial factors, such as family support, patient's motivation, or commitment to rehabilitate. Few programs used validated instruments to assess risk of relapse in AAH patients. Fourteen percent of programs transplant patients actively using marijuana and an additional 28% of programs listed patients using marijuana provided they discontinue by the time of OLT. Active methadone users were accepted in 45% of the programs.
Policies regarding alcohol use have become more flexible particularly toward patients with AAH. Marijuana use is also more accepted. Although policies regarding alcohol and marijuana have changed significantly in the last decade, they remain highly variable among programs.
酒精性肝病是进行原位肝移植（OLT）的常见适应证。尽管 OLT 已被证明可使急性酒精性肝炎（AAH）患者获益，但历史上大多数项目都要求在 OLT 前进行 6 个月的戒酒期，这将 AAH 患者排除在外。大麻在美国超过一半的州已合法化。这项对肝移植项目的调查旨在评估当前与酒精、大麻和美沙酮使用相关的政策。
向北美 100 个获得联合器官共享网络批准的肝移植项目分发了一份问卷，这些项目在过去 5 年中每年至少进行 30 例肝移植。
49 个项目作出了回应。只有 43%的项目要求在进行酒精性肝病的 OLT 前有特定的戒酒期，只有 26%执行 6 个月的戒酒政策。对于 AAH 患者，71%的项目豁免了 6 个月的戒酒要求，并考虑了社会心理因素，如家庭支持、患者的动机或康复承诺。很少有项目使用经过验证的工具来评估 AAH 患者复发的风险。14%的项目移植了正在积极使用大麻的患者，另有 28%的项目列出了正在使用大麻的患者，前提是他们在 OLT 前停止使用。45%的项目接受正在使用美沙酮的患者。
关于酒精使用的政策已经变得更加灵活，尤其是针对 AAH 患者。大麻的使用也更被接受。尽管在过去十年中，关于酒精和大麻的政策发生了重大变化，但它们在项目之间仍然存在很大差异。
