Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital Padua, University of Padua, Padua, Italy.
Service des Maladies de l'appareil Digestif, Hôpital Huriez, CHU Lille, France.
J Hepatol. 2023 Jun;78(6):1130-1136. doi: 10.1016/j.jhep.2023.03.007.
In patients with severe acute alcohol-related hepatitis not responding to medical therapy, early liver transplantation (LT) represents the only effective therapy and, when performed within strict and well-defined protocols, it is associated with a clear survival benefit and acceptable rates of return to alcohol use after transplantation. However, there is still high variability in access to LT for patients with severe alcohol-related hepatitis, mainly due to a persistent overemphasis in the pre-LT evaluation on duration of pre-transplant abstinence and the stigma that patients with alcohol-related liver disease often experience, leading to marked inequity of access to this potentially lifesaving procedure and negative health outcomes. Therefore, there is an increasing need for prospective multicentre studies focusing on pre-transplant selection practices and on better interventions to treat alcohol use disorder after LT.
在对医学治疗无反应的重症急性酒精相关性肝炎患者中，早期肝移植（LT）是唯一有效的治疗方法，并且当在严格和明确界定的方案中进行时，它与明显的生存获益和可接受的移植后恢复饮酒率相关。然而，重症酒精相关性肝炎患者获得 LT 的机会仍然存在很大差异，主要是由于在 LT 前评估中仍然过分强调移植前戒酒的持续时间，以及酒精性肝病患者经常面临的耻辱感，这导致获得这种潜在救命手术的机会明显不平等，以及健康结果不佳。因此，越来越需要前瞻性多中心研究，重点关注 LT 前的选择实践以及更好的治疗 LT 后酒精使用障碍的干预措施。
