Belli Luca S, Panariello Adelaide, Perricone Giovanni, Prandoni Paola, Viganò Raffaella, Mazzarelli Chiara, Becchetti Chiara, Giacalone Sara, Donvito Giovanna, Conti Sara, Cortesi Paolo A, Roselli Elena, Monti Gianpaola, Carbone Marco, De Carlis Luciano G, Percudani Mauro
Hepatology and Gastroenterology Unit, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy.
Mental Diseases Unit, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy.
Transpl Int. 2025 Jan 6;37:13451. doi: 10.3389/ti.2024.13451. eCollection 2024.
Patients with severe alcoholic hepatitis SAH may suffer of undiagnosed psychiatric illnesses, typically depression. Assessment of prevalence and potential impact of psychiatric disturbances on alcohol relapse after LT, were the main objectives of this study. One hundred consecutive patients with SAH from April 2016 to May 2023 were analyzed. All patients were evaluated by an integrated team including psychiatrists, addiction specialists and social workers. Thirty (30%) were listed, of whom 25 underwent early liver transplantation (eLT) after a median time of 36 days from the index episode of SAH with a median model for end stage liver disease (MELD) score of 36, whereas 33 (33%) were excluded, with psycho-social issues being the main cause of exclusion in 18 patients (54.5%). Twenty-four patients (96%) are currently alive after a median follow-up of 32 months from LT. Sixteen transplanted patients had major depression with or without anxiety, with 10 patients (33%) being treated with antidepressants post-LT. Overall, 4 patients (16%) relapsed into alcohol consumption after liver transplantation and 1 died of alcohol related liver disease (4%). From this experience emerged that psychiatric comorbidities are highly prevalent among patients with SAH and that their diagnosis/treatment contributed to mitigate the risk of alcohol relapse.
重症酒精性肝炎（SAH）患者可能患有未被诊断出的精神疾病，典型的是抑郁症。评估精神障碍的患病率及其对肝移植后酒精复饮的潜在影响是本研究的主要目标。对2016年4月至2023年5月期间连续收治的100例SAH患者进行了分析。所有患者均由包括精神科医生、成瘾专家和社会工作者在内的综合团队进行评估。其中30例（30%）被列入名单，其中25例在SAH首发事件发生后中位时间36天、终末期肝病模型（MELD）评分中位值为36时接受了早期肝移植（eLT），而33例（33%）被排除，社会心理问题是18例患者（54.5%）被排除的主要原因。肝移植后中位随访32个月，24例患者（96%）目前仍存活。16例移植患者患有重度抑郁症，伴或不伴有焦虑症，10例患者（33%）在肝移植后接受了抗抑郁药治疗。总体而言，4例患者（16%）在肝移植后复饮酒精，1例死于酒精性肝病（4%）。从这一经验可以看出，精神共病在SAH患者中非常普遍，其诊断/治疗有助于降低酒精复饮的风险。
