Department of Medicine, University of South Dakota, Vermillion, South Dakota, USA.
Department of Gastroenterology and Hepatology, Avera McKennan University Hospital, Sioux Falls, South Dakota, USA.
Liver Transpl. 2024 Feb 1;30(2):200-212. doi: 10.1097/LVT.0000000000000296. Epub 2023 Nov 8.
Alcohol-associated liver disease (ALD) has emerged as the leading indication for liver transplantation (LT) worldwide, with 40% of LTs in the United States performed for ALD in 2019. The ALD-related health care burden accelerated during the COVID-19 pandemic, especially in young individuals. Alcohol use disorder (AUD), which focuses on the negative effects of alcohol on psychosocial, physical, and mental health, is present in the majority of patients with ALD, with moderate to severe AUD in 75%-80%. During the last decade, early liver transplantation (eLT) has emerged as a lifesaving treatment for selected patients with alcohol-associated hepatitis; these patients may have a higher risk of using alcohol after LT. The risk of alcohol use recurrence may be reduced during the pretransplant or post-transplant period with AUD treatment using behavioral and/or pharmacological therapies and with regular monitoring for alcohol use (self-reported and complemented with biomarkers like phosphatidylethanol). However, AUD treatment in patients with ALD is challenging due to patient, clinician, and system barriers. An integrated model to provide AUD and ALD care by hepatologists and addiction experts in a colocated clinic starting from LT evaluation and selection to monitoring listed candidates and then to following up on recipients of LT should be promoted. However, the integration of addiction and hepatology teams in an LT program in the real world is often present only during evaluation and candidate selection for LT. Data are emerging to show that a multidisciplinary integrated AUD treatment within an LT program reduces recurrent alcohol use after LT. If we want to continue using early liver transplantation for patients with severe alcohol-associated hepatitis, LT programs should focus on building integrated multidisciplinary care teams for the integrated treatment of both AUD and ALD.
酒精相关性肝病（ALD）已成为全球范围内肝移植（LT）的主要适应证，2019 年美国 40%的 LT 用于 ALD。在 COVID-19 大流行期间，ALD 的相关医疗保健负担加速增加，尤其是在年轻人中。酒精使用障碍（AUD）主要关注酒精对心理社会、身体和心理健康的负面影响，在大多数 ALD 患者中存在，其中 75%-80%的患者存在中重度 AUD。在过去十年中，早期肝移植（eLT）已成为治疗特定酒精相关性肝炎患者的救命治疗方法；这些患者在 LT 后可能有更高的饮酒风险。在 AUD 治疗中，使用行为和/或药理学疗法，以及定期监测酒精使用（自我报告，并辅以磷脂酰乙醇等生物标志物），可降低肝移植前或移植后酒精使用复发的风险。然而，由于患者、临床医生和系统障碍，ALD 患者的 AUD 治疗具有挑战性。应推广由肝科医生和成瘾专家在联合诊所提供 AUD 和 ALD 护理的综合模式，从 LT 评估和选择开始，对列入名单的候选人进行监测，然后对 LT 受者进行随访。然而，在现实世界中，LT 项目中成瘾和肝脏病团队的整合通常仅在 LT 的评估和候选选择期间存在。有数据表明，LT 项目中多学科综合 AUD 治疗可减少 LT 后复发性饮酒。如果我们想继续为严重酒精相关性肝炎患者使用早期肝移植，LT 项目应专注于建立综合多学科护理团队，综合治疗 AUD 和 ALD。
