From the Department of Surgery, Montefiore Medical Center, New York, USA.
the Koc University Hospital, Organ Transplantation Center, Istanbul, Turkey.
Exp Clin Transplant. 2021 May;19(5):439-444. doi: 10.6002/ect.2020.0189. Epub 2021 Jan 11.
With limited data on the morbidity profile of liver transplant as therapy for alcoholic hepatitis, we compared 30-day and 1-year morbidity in liver transplant recipients with alcoholic hepatitis versus alcoholic cirrhosis.
We retrospectively reviewed 38 perioperative variables in patients with alcoholic hepatitis (n = 15) and with alcoholic cirrhosis (n = 46). Multivariable analysis was performed to identify factors independently associated with outcomes.
Patients with alcoholic hepatitis were younger (43 vs 58 years; P = .001), with higher pretransplant Model for End-Stage Liver Disease scores (36 vs 29; P = .009) and worse Karnofsky scores (20 vs 50; P < .001). All patients with alcoholic hepatitis received standard criteria deceased donor grafts; however, in the alcoholic cirrhosis group, 64% received standard criteria deceased, 11% living, 11% after cardiac death, 9% extended criteria, and 2% split graft donor organ donations (P > .05). The alcoholic hepatitis group had higher degree of steatosis on explant (P < .005), and the alcoholic cirrhosis group had higher 30-day reoperation rate (P = .001); however, 1-year interventions, vascular and biliary complications, graft and patient survival, and all other variables were similar (P > .05). Rates of alcohol relapse, 1-year infection, and 1-year rejection were higher but not significant (P > .05) in the alcoholic hepatitis group. Thirty-day reoperation (odds ratio of 82.63; 95% CI, 8.02-3338.96; P = .002) and Karnofsky scores (odds ratio of 1.18; 95% CI, 1.08-1.36; P = .006) remained significant on multivariate analysis.
Our results showed significant differences between our patient groups, including worse functional status in the alcoholic hepatitis group but significantly higher 30-day reoperation rates and more variable grafts in the alcoholic cirrhosis group, although both groups had similar overall 1-year complication and survival rates. Although not significant, patients with alcoholic hepatitis had higher alcohol relapse and 1-year infection and rejection rates. A larger cohort is necessary to confirm the strength of these findings.
由于关于肝移植治疗酒精性肝炎发病率的资料有限，我们比较了酒精性肝炎（n=15）和酒精性肝硬化（n=46）患者的 30 天和 1 年发病率。
我们回顾性分析了 15 例酒精性肝炎患者和 46 例酒精性肝硬化患者的 38 个围手术期变量。采用多变量分析确定与结局相关的独立因素。
酒精性肝炎患者年龄较轻（43 岁 vs 58 岁；P=0.001），术前终末期肝病模型评分较高（36 分 vs 29 分；P=0.009），卡诺夫斯基评分较低（20 分 vs 50 分；P<0.001）。所有酒精性肝炎患者均接受了标准标准供体移植；然而，在酒精性肝硬化组中，64%接受了标准标准供体，11%接受了活体供体，11%接受了心脏死亡供体，9%接受了扩展标准供体，2%接受了分体供体器官捐赠（P>0.05）。酒精性肝炎组肝组织标本中脂肪变性程度较高（P<0.005），30 天再手术率较高（P=0.001）；然而，1 年干预、血管和胆道并发症、移植物和患者存活率以及所有其他变量均相似（P>0.05）。酒精性肝炎组的酒精复发率、1 年感染率和 1 年排斥率较高，但无统计学意义（P>0.05）。30 天再手术（优势比 82.63；95%置信区间，8.02-3338.96；P=0.002）和卡诺夫斯基评分（优势比 1.18；95%置信区间，1.08-1.36；P=0.006）在多变量分析中仍具有统计学意义。
我们的研究结果显示两组患者存在显著差异，包括酒精性肝炎组的功能状态较差，但酒精性肝硬化组的 30 天再手术率较高，移植物类型更多，尽管两组的 1 年总并发症和存活率相似。虽然没有统计学意义，但酒精性肝炎患者的酒精复发率、1 年感染率和 1 年排斥率较高。需要更大的队列来证实这些发现的强度。
