Institute of Liver, Gastroenterology, & Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, New Delhi, India.
Clin Mol Hepatol. 2018 Mar;24(1):43-50. doi: 10.3350/cmh.2017.0027. Epub 2018 Jan 10.
Severe alcoholic hepatitis has very high short term mortality and corticosteroids have been the mainstay of treatment for decades. Patients with Lille score >0.45 are considered non-responders to steroids and have poor outcome. Recently Orthotopic Liver Transplantation (OLT) is being increasingly used as rescue treatment for these patients, without waiting for 6 months of abstinence. Liver transplant is the only rescue treatment which can potentially provide long term benefit for patients who are steroid non-responders. However, with scarcity of organs being a concern, all patients of severe alcoholic hepatitis cannot be chosen for transplantation in an arbitrary way. There is a need for development of predictive tools and objective protocols to select patients who can justify the use of precious liver grafts. With a stringent criteria for selection of patients receiving the graft, liver transplantation in severe alcoholic hepatitis can become a viable rescue therapeutic option conferring significant survival advantage of both short- and long-term basis. The optimal criteria for selection will also prevent misuse of the liver donor pool as well as to prevent mortality in salvageable patients. Further research needs to be done to identify subset of patients which are at low risk of recidivism and also cannot be managed with pharmacotherapy alone. We reviewed the current knowledge on role of OLT in patient with acute severe alcoholic hepatitis in the present review.
严重酒精性肝炎的短期死亡率非常高，皮质类固醇已成为治疗该病的主要方法已有数十年。Lille 评分>0.45 的患者被认为对类固醇无反应，预后不良。最近，肝移植（OLT）越来越多地被用作这些患者的抢救治疗方法，而无需等待 6 个月的戒酒期。肝移植是唯一一种可能为对类固醇无反应的患者提供长期获益的抢救治疗方法。然而，由于器官短缺是一个令人关注的问题，并非所有严重酒精性肝炎患者都可以任意选择进行移植。需要开发预测工具和客观方案来选择可以证明使用宝贵的肝移植物合理的患者。通过严格的标准选择接受移植的患者，可以使肝移植成为严重酒精性肝炎的可行抢救治疗选择，在短期和长期基础上均能显著提高生存率。最佳选择标准还将防止对供肝库的滥用，并防止可挽救患者的死亡率。需要进一步研究以确定复发风险低且不能仅通过药物治疗来管理的患者亚组。我们在本次综述中回顾了 OLT 在急性严重酒精性肝炎患者中的作用的现有知识。
