Rachakonda Vikrant, Bataller Ramon, Duarte-Rojo Andres
Division of Gastroenterology and Hepatology, Starzl Transplantation Institute, and Pittsburgh Liver Research Center, University of Pittsburgh, Pittsburgh, PA, 15213, USA.
F1000Res. 2020 Feb 10;9. doi: 10.12688/f1000research.20394.1. eCollection 2020.
Alcoholic hepatitis is the severest clinical presentation of alcoholic liver disease. Lacking an effective pharmacologic treatment, alcoholic hepatitis is associated with a poor prognosis and its recovery relies mostly on abstinence. With alcohol use disorder being universally on the rise, the impact of alcoholic hepatitis on society and health-care costs is expected to increase significantly. Prognostic factors and liver biopsy can help with timely diagnosis, to determine eligibility and response to corticosteroids, and for prognostication and transplant referral. Although recent discoveries in the pathophysiology of alcoholic hepatitis are encouraging and could pave the way for novel treatment modalities, a multidisciplinary approach considering timely identification and treatment of liver-related complications, infectious and metabolic disease, malnutrition, and addiction counseling should be emphasized. Apart from proper selection of candidates, transplant programs should provide adequate post-transplant addiction support in order to make of early liver transplantation for alcoholic hepatitis the ultimate sobering experience in the next decade.
酒精性肝炎是酒精性肝病最严重的临床表现。由于缺乏有效的药物治疗，酒精性肝炎预后较差，其恢复主要依赖于戒酒。随着酒精使用障碍在全球范围内普遍增加，酒精性肝炎对社会和医疗成本的影响预计将显著上升。预后因素和肝活检有助于及时诊断，确定是否适合使用皮质类固醇及其反应情况，还能用于预后评估和移植转诊。尽管酒精性肝炎病理生理学方面的最新发现令人鼓舞，并可能为新的治疗方式铺平道路，但仍应强调采用多学科方法，包括及时识别和治疗肝脏相关并发症、感染性和代谢性疾病、营养不良以及提供成瘾咨询。除了正确选择候选者外，移植项目还应提供充分的移植后成瘾支持，以便在未来十年使酒精性肝炎的早期肝移植成为最终的清醒体验。
