Choudhary Narendra S, Saraf Neeraj, Mehrotra Saurabh, Saigal Sanjiv, Soin Arvinder S
Institute of Liver Transplantation and Regenerative Medicine, Medanta the Medicity, Gurgaon, Delhi (NCR), India.
Department of Mental Health, Medanta the Medicity, Gurgaon, Delhi (NCR), India.
J Clin Exp Hepatol. 2021 May-Jun;11(3):387-396. doi: 10.1016/j.jceh.2020.08.011. Epub 2020 Sep 6.
Liver transplantation (LT) is the only cure for patients with end-stage liver disease, which offers good long-term survival. The long-term issues after LT affecting survival are cardiovascular disease, chronic kidney disease, de novo malignancies, recurrence of original disease and immunological causes. Alcoholic-related liver disease (ALD) is one of the most common indications for LT worldwide including India. LT for ALD is associated with several unique challenges as compared with other etiologies. Long-term survival after LT in patients with ALD is affected by recidivism. Various studies have shown different predictors of relapse; the main predictors of relapse are pretransplant abstinence, psychiatric comorbidities, and lack of social support. Although several risk scores have been proposed, these scores are not validated. Studies with active involvement of psychiatrist have shown lower relapse rates. The relapse prevention strategy for reducing likelihood and severity of relapse after initial cessation of alcohol uses a combination of pharmacotherapy and cognitive behavioral approach (identifying and addressing high-risk situations for relapse).
肝移植(LT)是终末期肝病患者的唯一治愈方法,能带来良好的长期生存率。肝移植后影响生存的长期问题包括心血管疾病、慢性肾病、新发恶性肿瘤、原发病复发以及免疫相关原因。酒精性肝病(ALD)是包括印度在内的全球范围内肝移植最常见的适应证之一。与其他病因相比,ALD患者的肝移植存在一些独特挑战。ALD患者肝移植后的长期生存受复饮影响。多项研究显示了不同的复发预测因素;复发的主要预测因素是移植前戒酒、精神疾病共病以及缺乏社会支持。尽管已经提出了几种风险评分,但这些评分尚未得到验证。有精神科医生积极参与的研究显示复发率较低。预防复饮的策略是在最初戒酒之后降低复发可能性和严重程度,采用药物治疗和认知行为方法相结合的方式(识别并应对复发的高危情况)。