Système gastro-intestinal et digestif

Abstrait

Place of Liver Transplant in Alcoholic Hepatitis

Khalid Rasheed, Sumant Arora, Ronak V Patel, Rehan Sarmad, Gary A Abrams

In the United States and Europe, after viral hepatitis, alcoholic liver disease (ALD) is the second most commonly recognized indication for liver transplantation. Issues of conflicting data on six-month abstinence, eligibility criteria for selection of patients, and clarity of definition of post-transplant relapse are still under debate. Despite high early mortality, acute alcoholic hepatitis continues to be a contraindication to transplant despite data demonstrating the successful outcome of liver transplantation in these individuals. Disagreements arise due to the trepidation that these patients may relapse resulting in damage to the graft or non-compliance causing graft rejection. However, 1- year, 3-year, and 5-year patient and graft survival after transplant are comparable to transplantation for other etiologies. Studies have revealed that pre-OLT abstinence is a poor forecaster of post-OLT relapse. Life-threatening liver failure can potentially develop in this time frame, resulting in augmentation in waitlist mortality. Due to the paucity of available livers for donation, it is considered by many authorities to be obligatory to choose candidates with a lesser risk for relapse with the utilization of existing prophetic factors and mandatory clinical and psychological pre-transplant evaluations by substance abuse specialists and psychiatrists/psychologists. There is concern that if amendments in guidelines for liver transplantation are made for these patients, it may lead to a significant decline in willingness to donate. However, patients with fulminant hepatic failure due to intentional acetaminophen poisoning or due to intravenous-drug use-related acute hepatitis-B virus infection, did not come across this issue. Therefore, a further exploration into this field and these issues is needed.