Icahn School of Medicine at Mount Sinai, Division of Liver Diseases, Recanati-Miller Transplantation Institute, New York NY, USA.
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore MD, USA.
J Hepatol. 2019 Feb;70(2):328-334. doi: 10.1016/j.jhep.2018.11.007.
While liver transplantation (LT) has become a standard therapy for life-threatening alcohol related cirrhosis, LT as a treatment for severe alcoholic hepatitis (AH) has remained a taboo owing to concerns about the limited organ supply and the risk that the AH liver recipient will return to harmful drinking. The adoption of a 6-month abstinence requirement (the so-called '6-month rule') by many centres made AH a contraindication to LT. Given the high short-term mortality of severe AH, the lack of effective medical therapies and an increasing recognition that the 6-month rule unfairly excluded otherwise favourable candidates, a seminal European pilot study of LT for AH was performed. The success of the European study, which has been corroborated in retrospective analyses from the United States, represented a paradigm shift in therapy for highly selected patients with severe AH who are not responding to medical therapy. However, prospective studies are urgently needed to resolve the controversies that still surround the criteria for selection of patients with AH for LT and the long-term outcomes of the associated alcohol use disorder.
虽然肝移植（LT）已成为治疗危及生命的酒精相关性肝硬化的标准疗法，但由于担心器官供应有限，以及酒精性肝炎（AH）肝受体可能会重新开始有害饮酒的风险，LT 作为严重酒精性肝炎的治疗方法仍然是禁忌。由于许多中心采用了 6 个月戒酒要求（所谓的“6 个月规则”），因此 AH 成为 LT 的禁忌症。鉴于严重 AH 的短期死亡率高，缺乏有效的医学治疗方法，以及越来越认识到 6 个月规则不公平地排除了其他有利的候选者，因此对 AH 进行 LT 的欧洲试点研究。这项欧洲研究取得了成功，在美国的回顾性分析中也得到了证实，这代表着对不符合医学治疗标准的严重 AH 高度选择患者的治疗方法发生了范式转变。然而，迫切需要进行前瞻性研究来解决仍然围绕着选择 AH 患者进行 LT 的标准和相关酒精使用障碍的长期结果的争议。
