Service des Maladies de l'Appareil Digestif, Université Lille 2, and INSERM U995, Lille, France.
Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Lancet Gastroenterol Hepatol. 2020 May;5(5):507-514. doi: 10.1016/S2468-1253(19)30451-0.
The survival of patients with alcohol-related liver disease who receive a liver transplant has steadily improved to reach 80-85% at 1 year post-transplantation. The standard requirement for liver transplant-abstinence from alcohol for 6 months before transplantation-has been applied widely, but few data support the use of this rule as the sole criterion for selecting candidates for liver transplantation. When determining the suitability of a patient for transplantation, many liver transplant programmes now try to balance the period of abstinence against the risk of death associated with the severity of liver damage. Data accumulated since 2011 suggest that early liver transplantation (ie, transplantation without a specific period of abstinence) in patients with severe alcoholic hepatitis who do not respond to medical therapy is an effective therapeutic strategy. Further studies are needed to help refine the selection of patients with alcohol-related liver disease who have been abstinent for less than 6 months as suitable liver transplant candidates, and to improve the treatment of alcohol use disorder in those patients who have received a liver transplant.
接受肝移植的酒精性肝病患者的生存率稳步提高，移植后 1 年达到 80-85%。肝移植的标准要求是在移植前戒酒 6 个月，但很少有数据支持将这一规定作为选择肝移植候选人的唯一标准。在确定患者是否适合移植时，许多肝移植项目现在试图在戒酒期和与肝损伤严重程度相关的死亡风险之间取得平衡。自 2011 年以来积累的数据表明，对于对药物治疗无反应的严重酒精性肝炎患者，早期肝移植（即无需特定戒酒期的移植）是一种有效的治疗策略。需要进一步的研究来帮助完善选择戒酒时间不足 6 个月的酒精性肝病患者作为合适的肝移植候选者，并改善那些接受肝移植的患者的酒精使用障碍治疗。
