Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA.
Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA.
Liver Transpl. 2023 Jul 1;29(7):757-767. doi: 10.1097/LVT.0000000000000144. Epub 2023 Apr 6.
Alcohol accounts for a large disease burden in hepatology and liver transplantation (LT) and across the globe. Clinical evaluations and decisions about LT candidacy are challenging because they rely on detailed psychosocial assessments and interpretations of psychiatric and substance use disorder data, which often must occur rapidly according to the acuity of end-stage liver disease. Such difficulties commonly occur during the process of candidate selection and liver allocation, particularly during early LT (eLT) in patients with acute alcohol-associated hepatitis (AAH). Patients with AAH commonly have very recent or active substance use, high short-term mortality, psychiatric comorbidities, and compressed evaluation and treatment timetables. LT clinicians report that patients' alcohol-associated insight (AAI) is among the most relevant psychosocial data in this population, yet no studies exist examining how LT teams define and use AAI in eLT or its effect on clinical outcomes. In April 2022, we searched Ovid MEDLINE, Elsevier Embase, EBSCOhost PsycInfo and CINAHL, and Wiley Cochrane Central Register of Controlled Trials for reports describing AAH populations who underwent eLT, which also described psychosocial evaluation parameters. The searches retrieved 1603 unique reports. After eligibility screening, 8 were included in the qualitative analysis. This systematic review reveals that AAI is a poorly defined construct that is not measured in a standardized way. Yet it is a commonly cited parameter in articles that describe the psychosocial evaluation and decision-making of patients undergoing eLT for AAH. This article also discusses the general challenges of assessing AAI during eLT for AAH, existing AAI definitions and rating scales, how AAI has been used to date in the broader hepatology and LT literature, and future areas for clinical and research progress.
酒精在肝病学和肝移植（LT）以及全球范围内造成了很大的疾病负担。LT 候选者的临床评估和决策具有挑战性，因为它们依赖于详细的社会心理评估以及对精神和物质使用障碍数据的解释，而这些数据通常必须根据终末期肝病的紧迫性迅速进行。在候选者选择和肝脏分配过程中，通常会出现这种困难，尤其是在急性酒精性肝炎（AAH）患者的早期 LT（eLT）中。AAH 患者通常有近期或活跃的物质使用史、高短期死亡率、精神共病以及评估和治疗时间紧迫。LT 临床医生报告称，患者的酒精相关洞察力（AAI）是该人群中最相关的社会心理数据之一，但目前尚无研究探讨 LT 团队如何在 eLT 中定义和使用 AAI 及其对临床结果的影响。2022 年 4 月，我们在 Ovid MEDLINE、Elsevier Embase、EBSCOhost PsycInfo 和 CINAHL 以及 Wiley Cochrane 对照试验中心注册库中进行了检索，以查找描述接受 eLT 的 AAH 人群的报告，这些报告还描述了社会心理评估参数。检索共获取了 1603 份独特的报告。经过资格筛选，有 8 份报告被纳入定性分析。本系统评价表明，AAI 是一个定义不明确的概念，没有以标准化的方式进行测量。然而，它是描述接受 eLT 的 AAH 患者社会心理评估和决策的文章中常被引用的参数。本文还讨论了在 AAH 的 eLT 期间评估 AAI 的一般挑战、现有的 AAI 定义和评分量表、迄今为止 AAI 在更广泛的肝病学和 LT 文献中的使用情况，以及未来的临床和研究进展领域。
