Simonetto Douglas A, Winder Gerald Scott, Connor Ashton A, Terrault Norah A
Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Departments of Surgery and Psychiatry, Henry Ford Health, Detroit, Michigan.
Hepatology. 2024 Dec 1;80(6):1441-1461. doi: 10.1097/HEP.0000000000000978. Epub 2024 Jun 18.
Alcohol-associated liver disease (ALD) is a major cause of morbidity and mortality worldwide, and a leading indication for liver transplantation (LT) in many countries, including the United States. However, LT for ALD is a complex and evolving field with ethical, social, and medical challenges. Thus, it requires a multidisciplinary approach and individualized decision-making. Short-term and long-term patient and graft survival of patients undergoing LT for ALD are comparable to other indications, but there is a continued need to develop better tools to identify patients who may benefit from LT, improve the pretransplant and posttransplant management of ALD, and evaluate the impact of LT for ALD on the organ donation and transplantation systems. In this review, we summarize the current evidence on LT for ALD, from alcohol-associated hepatitis to decompensated alcohol-associated cirrhosis. We discuss the indications, criteria, outcomes, and controversies of LT for these conditions and highlight the knowledge gaps and research priorities in this field.
酒精性肝病(ALD)是全球发病和死亡的主要原因,在包括美国在内的许多国家,是肝移植(LT)的主要指征。然而,ALD的肝移植是一个复杂且不断发展的领域,面临伦理、社会和医学挑战。因此,它需要多学科方法和个体化决策。ALD患者接受肝移植的短期和长期患者及移植物存活率与其他指征相当,但仍持续需要开发更好的工具来识别可能从肝移植中获益的患者,改善ALD患者移植前和移植后的管理,并评估ALD肝移植对器官捐赠和移植系统的影响。在本综述中,我们总结了目前关于ALD肝移植的证据,从酒精性肝炎到失代偿期酒精性肝硬化。我们讨论了这些情况下肝移植的指征、标准、结果和争议,并强调了该领域的知识空白和研究重点。