Department of Medicine.
Department of Surgery, University of California at Los Angeles, California, Los Angeles, USA.
Curr Opin Gastroenterol. 2020 May;36(3):157-163. doi: 10.1097/MOG.0000000000000623.
Alcoholic liver disease continues to be a major public health concern in the United States and around the world. Alcoholic liver disease remains the third most common indication for liver transplantation in the United States. Mortality has been reported in up to 30-50% of patients with severe alcoholic hepatitis. Liver transplantation can be lifesaving for patients with alcoholic hepatitis. Liver transplantation for alcoholic liver disease was traditionally only considered in patients who have achieved 6 months of abstinence. The majority of patients with severe alcoholic hepatitis who fail medical therapy will not live long enough to meet this requirement. The purpose of this review is to provide an update from the most recent peer reviewed articles regarding early liver transplantation of alcoholic hepatitis.
This review shows that liver transplantation offers the best survival benefit to patients with alcoholic hepatitis. Selection criteria is a key component for a successful transplant. No change in 1-year graft survival between patients who have 6 months sobriety vs. those transplanted prior to 6 months abstinence. Liver transplantation is limited by very narrow selection criteria and limited long-term data.
Liver transplantation offers the best survival benefit to patients with alcoholic hepatitis. Selection criteria of patients has evolved and have become more permissive and the period of sobriety has become less important in the evaluation of process. However, long-term outcomes continue to lack in the literature. On the basis of previous studies, patients with longer pretransplant abstinence, disease process insight, older age at the time of transplant, the presence of social support that lives with the patient in the same dwelling place were noted to have lower rates of return to alcohol use after liver transplantation.
在美国和世界各地，酒精性肝病仍然是一个主要的公共卫生关注点。在美国，酒精性肝病仍然是肝移植的第三大常见指征。据报道，严重酒精性肝炎患者的死亡率高达 30-50%。肝移植可以拯救酒精性肝炎患者的生命。传统上，只有在患者戒酒 6 个月后，才会考虑对酒精性肝病进行肝移植。大多数经药物治疗失败的严重酒精性肝炎患者，其存活时间不足以满足这一要求。本文的目的是根据最近的同行评审文章，提供关于酒精性肝炎早期肝移植的最新信息。
本综述表明，肝移植为酒精性肝炎患者提供了最佳的生存获益。选择标准是移植成功的关键组成部分。在戒酒 6 个月的患者与在戒酒 6 个月之前接受移植的患者之间，1 年移植物存活率没有差异。肝移植受到非常严格的选择标准和有限的长期数据的限制。
肝移植为酒精性肝炎患者提供了最佳的生存获益。患者的选择标准已经演变，变得更加宽松，戒酒时间在评估过程中的重要性降低。然而，长期结果在文献中仍然缺乏。根据以往的研究，在肝移植前有更长的戒酒期、对疾病过程有深入了解、在移植时年龄较大、有与患者同住一个住所的社会支持的患者，在肝移植后再次饮酒的比率较低。
