Sedki Mai, Ahmed Aijaz, Goel Aparna
Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA.
Transl Gastroenterol Hepatol. 2022 Jul 25;7:26. doi: 10.21037/tgh-2020-13. eCollection 2022.
In the past decade, alcohol-related liver disease (ALD) has become the leading indication for liver transplantation (LT) in the United States. Despite this major development, there still remains some controversy in a distinct subset of this patient population, those presenting with alcoholic hepatitis (AH). There is significant debate within the transplant community regarding acceptance criteria for patients with AH requiring LT, especially those with less than 6 months of sobriety. With that being said, LT in the setting of ALD and AH has shown an improvement in survival rates; additionally, many studies have reported that careful selection of patients with ALD has produced excellent post-transplant outcomes even if transplant occurred with less than 6 months of sobriety. In this review, we aim to discuss the ethical and allocation-associated issues that arise when considering ALD and/or AH for LT; furthermore, we delve into the history, controversies, current guidelines, and future directions of LT in this subgroup.
在过去十年中，酒精性肝病（ALD）已成为美国肝移植（LT）的主要适应证。尽管有这一重大进展，但在该患者群体的一个特定子集中，即那些患有酒精性肝炎（AH）的患者中，仍存在一些争议。移植界对于需要肝移植的酒精性肝炎患者的接受标准，尤其是那些戒酒时间少于6个月的患者，存在重大争论。话虽如此，在酒精性肝病和酒精性肝炎背景下进行的肝移植已显示出存活率有所提高；此外，许多研究报告称，即使在戒酒时间少于6个月的情况下进行移植，对酒精性肝病患者的精心挑选也产生了出色的移植后结果。在本综述中，我们旨在讨论在考虑对酒精性肝病和/或酒精性肝炎患者进行肝移植时出现的伦理和分配相关问题；此外，我们深入探讨该亚组肝移植的历史、争议、当前指南以及未来方向。
