Germani Giacomo, D'Arcangelo Francesca, Grasso Marco, Burra Patrizia
Multivisceral Transplant Unit, Azienda Ospedale-Università Padova, Department of Surgery, Oncology and Gastroenterology, University of Padova, 35122 Padova, Italy.
Gastroenterology and Multivisceral Transplant Unit, Azienda Ospedale-Università Padova, Department of Surgery, Oncology and Gastroenterology, University of Padova, 35122 Padova, Italy.
Life (Basel). 2023 Aug 24;13(9):1802. doi: 10.3390/life13091802.
Alcohol-related hepatitis (AH) is a clinical syndrome characterized by recent-onset jaundice in the context of alcohol consumption. In patients with severe AH "unresponsive" to steroid therapy, mortality rates exceed 70% within six months. According to European and American guidelines, liver transplantation (LT) may be considered in highly selected patients who do not respond to medical therapy. The aim of this narrative review is to summarize current knowledge from medical therapy to liver transplantation in acute alcohol-related hepatitis. Due to the impossibility to guarantee six-month abstinence, LT for AH is controversial. Principal concerns are related to organ scarcity in the subset of stigma of "alcohol use disorder" (AUD) and the risk of relapse to alcohol use after LT. Return to alcohol use after LT is a complex issue that cannot be assessed as a yes/no variable with heterogeneous results among studies. In conclusion, present data indicate that well-selected patients have excellent outcomes, with survival rates of up to 100% at 24 and 36 months after LT. Behavioral therapy, ongoing psychological support, and strong family support seem essential to improve long-term outcomes after LT and reduce the risk in relapse of alcohol use.
酒精性肝炎（AH）是一种临床综合征，其特征为在饮酒情况下近期出现黄疸。在对类固醇治疗“无反应”的重度AH患者中，六个月内死亡率超过70%。根据欧美指南，对于药物治疗无反应的高度选择患者可考虑肝移植（LT）。本叙述性综述的目的是总结急性酒精性肝炎从药物治疗到肝移植的当前知识。由于无法保证六个月戒酒，AH的肝移植存在争议。主要问题与“酒精使用障碍”（AUD）耻辱感亚组中的器官短缺以及肝移植后酒精复饮风险有关。肝移植后酒精复饮是一个复杂问题，不能作为是/否变量进行评估，研究结果存在异质性。总之，现有数据表明，精心选择的患者有良好结局，肝移植后24个月和36个月生存率高达100%。行为疗法、持续的心理支持和强大的家庭支持似乎对于改善肝移植后的长期结局和降低酒精复饮风险至关重要。
