Department of Hepatobiliary Surgery & Liver Transplantation, The First Affiliated Hospital, Zhejiang University, Hangzhou 310003, China.
Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou 310003, China.
Can J Gastroenterol Hepatol. 2020 Sep 17;2020:8862152. doi: 10.1155/2020/8862152. eCollection 2020.
According to the recent data from the United Network for Organ Sharing database, alcohol-related liver disease (ARLD) accounts to be the most common indication of liver transplantation (LT) waiting lists in the United States among men without hepatocellular carcinoma (HCC). Severe alcoholic hepatitis (AH) is serious and the life-threatening form of ARLD and should be treated timely. However, the LT for severe AH remained to be controversial among the transplant community because of marked interests about the constrained organ supply and the hazard that the AH liver recipient will return to risky drinking. Early LT for ARLD refers for a patient with severe AH undergoing LT who are non-responder to medical treatments. These patients are generally on the existing waiting list but usually followed by 6-month duration of alcohol abstinence. However, the rule of 6-month alcohol abstinence need before the LT is ambiguous. The 6-month alcohol abstinence was consistently defended in light of the compelling fact that it would enable patients to recoup from the intense impacts of alcohol to the liver. In routine, however, the purported "6-month abstinence rule" turned into a surrogate for the forecast of future drinking by ARLD patients for the LT. Careful consideration should be given to the alcohol use disorder of craving and the hazard for recidivism after the LT. As for the current situation, there, urgently, is a specific need of standardized criteria for the evaluation of patients with severe AH for earlier LT. Moreover, further studies are required precisely to develop an accurate prediction model for posttransplant alcohol recidivism. Additionally, development of a standardized protocol for post-LT follow-up and management is further needed. We carefully outlined the published experience with the LT for ARLD in this review.
根据美国器官共享联合网络数据库的最新数据，在没有肝细胞癌 (HCC) 的男性中，酒精性肝病 (ARLD) 是美国肝移植 (LT) 等候名单上最常见的原因。严重酒精性肝炎 (AH) 是严重的、危及生命的 ARLD 形式，应及时治疗。然而，由于对有限的器官供应的明显关注以及 AH 肝受体返回危险饮酒的风险，严重 AH 的 LT 在移植界仍然存在争议。早期 ARLD 的 LT 是指对正在接受 LT 的严重 AH 患者进行 LT，这些患者通常对药物治疗没有反应。这些患者通常已经在现有的等候名单上，但通常需要在 LT 前进行为期 6 个月的戒酒。然而，LT 前 6 个月的戒酒规则并不明确。6 个月的戒酒规则一直以来都有明确的依据，即它可以使患者从酒精对肝脏的强烈影响中恢复过来。然而，在常规情况下，所谓的“6 个月戒酒规则”变成了预测 ARLD 患者 LT 后未来饮酒的替代指标。应该仔细考虑 LT 后患者对酒精的使用障碍和复发的风险。就目前情况而言，迫切需要制定用于早期 LT 的严重 AH 患者评估的标准化标准。此外，还需要进一步研究来精确开发用于预测移植后酒精复发的准确预测模型。此外，还需要制定 LT 后随访和管理的标准化方案。我们在这篇综述中仔细概述了发表的有关 ARLD 的 LT 经验。
