Unit of Gastroenterology and Multivisceral Transplant, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padua, Padua, Italy -
Unit of Gastroenterology and Multivisceral Transplant, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padua, Padua, Italy.
Minerva Gastroenterol (Torino). 2021 Mar;67(1):23-25. doi: 10.23736/S2724-5985.20.02778-6. Epub 2020 Nov 3.
Alcohol-related liver disease is one of the most prevalent liver diseases worldwide and is the second most common indication for liver transplantation. Most transplant programs require 6 months of abstinence prior to transplantation; commonly referred to as the "six-month rule." According to this rule, the patients admitted for severe acute alcoholic hepatitis are not eligible for liver transplantation in most transplant centers. However, there is increasing evidence that if liver transplantation is performed in selected patients after the first episode of severe decompensation with no response to steroid therapy, it represents an effective treatment. In such selected patients, the post-transplant outcomes are good with survival rates that are significantly higher when compared with patients not responding to medical therapy and not transplanted. A multidisciplinary assessment, involving several stakeholders such as a transplant hepatologist, transplant surgeon, psychologist and psychiatrist is becoming mandatory to properly evaluate the candidate to liver transplantation for alcoholic liver diseases and severe acute alcoholic hepatitis. In the clinical setting of severe acute alcoholic hepatitis, further studies are needed for the identification of accepted selection clinical and psychosocial criteria that can provide the best long-term results. The early liver transplantation option should therefore be explored within strict criteria for this setting.
酒精性肝病是全球最常见的肝脏疾病之一，也是肝移植的第二大常见适应证。大多数移植项目要求在移植前戒酒 6 个月；通常被称为“六个月规则”。根据这条规则，大多数移植中心的严重急性酒精性肝炎患者在入院时不符合肝移植的条件。然而，越来越多的证据表明，如果在首次严重失代偿发作后，对类固醇治疗无反应的情况下，对选定的患者进行肝移植，这是一种有效的治疗方法。在这些选定的患者中，肝移植后的预后良好，与未接受药物治疗和未移植的患者相比，生存率显著提高。多学科评估，涉及移植肝病专家、移植外科医生、心理学家和精神科医生等多个利益相关者，对于正确评估酒精性肝病和严重急性酒精性肝炎患者的肝移植候选者变得至关重要。在严重急性酒精性肝炎的临床环境中，需要进一步研究确定可提供最佳长期结果的公认的选择临床和社会心理标准。因此，对于这种情况，应该在严格的标准内探索早期肝移植的选择。
