Department of Internal Medicine, SS Annunziata Hospital, University of Ferrara, Cento, Ferrara, Italy.
Unit of Addiction and Hepatology, Alcohological Regional Center, ASL3 - IRCCS San Martino Hospital, Genoa, Italy -
Minerva Surg. 2021 Oct;76(5):444-449. doi: 10.23736/S2724-5691.20.08685-X. Epub 2021 Jan 12.
Worldwide, cirrhosis due to alcohol-related liver disease (ALD) is responsible for 0.9% of global deaths and 47.9% of cirrhosis-related deaths. End-stage ALD (ESALD) is the final condition of alcohol-related cirrhosis, and severe acute alcohol-related hepatitis (SAAH) is a distinct clinical syndrome associated with the consumption of large amounts of alcohol. In some cases, ESALD, and SAAH may need liver transplantation (LT). The severity of ESALD can improve after a few months (three months) of abstinence from alcohol, avoiding or delaying the need for LT. Conversely, patients with ESALD with a poor prognosis (MELD≥15) may be candidates for LT after three months of abstinence; in these patients, the 6 months rule needs to be revised. In addition, in non-responders to steroid therapy, the indication for early LT in patients with SAAH and acute on chronic liver failure (ACLF) due to alcohol use find indication in carefully selected patients (those with good insight into their alcohol problems and good social support). Thus, the role of a multi-disciplinary team of experts in the management of alcohol use disorder, ESALD and SAAH working in the same institution, the support of the patient's family and self-help groups represent a crucial approach in the reinforcement of motivation to abstain from alcohol, and in helping patients to avoid relapses in heavy drinking when entered in an LT program.
在全球范围内，酒精性肝病（ALD）导致的肝硬化占全球死亡人数的 0.9%，占肝硬化相关死亡人数的 47.9%。终末期酒精性肝病（ESALD）是酒精性肝硬化的终末期，严重急性酒精性肝炎（SAAH）是一种与大量饮酒相关的独特临床综合征。在某些情况下，ESALD 和 SAAH 可能需要进行肝移植（LT）。在戒酒几个月（三个月）后，ESALD 的严重程度可以改善，从而避免或延迟 LT 的需求。相反，预后不良（MELD≥15）的 ESALD 患者可能在戒酒三个月后成为 LT 的候选者；在这些患者中，需要修改 6 个月规则。此外，在类固醇治疗无反应的情况下，对于由于饮酒引起的 SAAH 和酒精性慢加急性肝衰竭（ACLF）的患者，早期 LT 的指征在经过精心选择的患者（那些对其酒精问题有良好洞察力和良好社会支持的患者）中发现。因此，在同一机构工作的酒精使用障碍、ESALD 和 SAAH 管理方面的多学科专家团队、患者家属的支持以及互助小组代表了强化戒酒动机和帮助患者避免 LT 程序中再次酗酒的关键方法。
