Paliard P, Mion F, Boillot O
Unité de Transplantation hépatique, Hôpital Edouard Herriot, Lyon.
Presse Med. 1995 May 20;24(18):859-62.
Alcoholic liver disease represents about 15% of all indications for liver transplantation. Patient selection is difficult, and must be rigorous. Peri-operative risks are evaluated on the same basis as for other chronic liver diseases, with special attention for alcoholic extra-hepatic morbidity and nutritional status. Definite withdrawal from alcohol is mandatory. Predictive factors of long-term abstinence are the absence of psychopathologic state, an adequate social and affective situation, the possibilities of professional reinsertion, and a strong motivation of the patient towards liver transplantation. A six-month period of complete abstinence before registration on a liver transplantation waiting list is not mandatory, although intermittent alcoholic abuse before transplantation should be an exclusion factor. Liver transplantation must be proposed based on the severity of liver failure, as assessed by pronostic scores. It must be rapidly discussed following an acute episode of decompensation, in the absence of a significant improvement despite adequate medical therapy. It must also be discussed for long-term abstinent patients, with an apparently stabilized cirrhosis, but with an important decrease of the functional liver mass. The evaluation of the functional liver mass is based upon the Child-Pugh score, associated with the results of metabolic liver function tests, the measurement of the hepatic volume and the severity of portal hypertension.
酒精性肝病约占肝移植所有适应证的15%。患者选择困难，且必须严格。围手术期风险的评估与其他慢性肝病相同，特别关注酒精性肝外疾病和营养状况。必须绝对戒酒。长期戒酒的预测因素包括无精神病理状态、适当的社会和情感状况、职业再融入的可能性以及患者对肝移植的强烈动机。在列入肝移植等候名单之前，并非强制要求有六个月的完全戒酒期，不过移植前的间歇性酒精滥用应作为排除因素。肝移植必须根据预后评分评估的肝衰竭严重程度来提出。在失代偿急性发作后，尽管进行了充分的药物治疗但无明显改善时，必须迅速讨论肝移植问题。对于长期戒酒、肝硬化明显稳定但功能性肝实质显著减少的患者，也必须讨论肝移植问题。功能性肝实质的评估基于Child-Pugh评分，并结合代谢肝功能试验结果、肝脏体积测量和门静脉高压的严重程度。
