Meeting Report: The Dallas Consensus Conference on Liver Transplantation for Alcohol Associated Hepatitis.
Meeting Report: The Dallas Consensus Conference on Liver Transplantation for Alcohol Associated Hepatitis.
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DOI：
10.1002/lt.25681
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发表时间：
2020-01
期刊：
影响因子：
--
通讯作者：
Klintmalm G
中科院分区：
文献类型：
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作者：
Asrani SK;Trotter J;Lake J;Ahmed A;Bonagura A;Cameron A;DiMartini A;Gonzalez S;Im G;Martin P;Mathurin P;Mellinger J;Rice JP;Shah VH;Terrault N;Wall A;Winder S;Klintmalm G
肝移植(LT)治疗酒精性肝炎(AH)仍存在争议。我们召开了一次协商一致的会议，研究了AH的LT的各个方面。我们的目标不是明确地支持LT for AH；相反，它是为执行或计划为AH执行LT的计划提出建议。在急性肝炎的情况下，确定接受肝移植的候选标准包括：(1)首次出现失代偿性肝病的急性肝炎患者，对药物治疗无反应，且没有严重的内科或精神合并症(2)移植前不要求固定的戒毒期(3)多学科心理社会小组的评估，包括一名社会工作者和一名具有成瘾和移植专业知识的成瘾专家/心理健康专业人员。支持因素包括没有多次失败的戒瘾尝试，没有使用/依赖其他药物，接受诊断/洞察力并承诺戒酒，以及正式同意坚持完全戒酒和咨询。对于有可能自行恢复的急性脑出血患者，应避免使用。必须达到与其他肝移植适应症相当的短期和长期存活率。LT不应因适应症、地理或其他社会人口学因素而进一步差异。酒精使用障碍的治疗应纳入肝移植前后的护理。随着这一适应症在更多的LT项目中得到更广泛的接受，全球AH的初始LT经验中描述的限制性和重点评估过程可能不会持续下去。选择过程的透明度对于收集客观数据以评估结果并将清单中的中心差异降至最低至关重要。对计划遵守情况的监督对于协调上市实践和结果至关重要。
Liver transplantation (LT) for alcohol related hepatitis (AH) remains controversial. We convened a consensus conference to examine various aspects of LT for AH. The goal was not to unequivocally endorse LT for AH; instead it was to propose recommendations for programs that perform or plan to perform LT for AH. Criteria were established to determine candidacy for LT in the setting of AH and included the following: (1) AH patients presenting for the first time with decompensated liver disease that are non-responders to medical therapy without severe medical or psychiatric comorbidities (2) A fixed period of abstinence prior to transplantation is not required (3) Assessment with a multidisciplinary psychosocial team including a social worker and a addiction specialist/mental health professional with addiction and transplantation expertise. Supporting factors include lack of repeated unsuccessful attempts at addiction rehabilitation, lack of other substance use/dependency, acceptance of diagnosis/insight with commitment of patient/family to sobriety and formalized agreement to adhere to total alcohol abstinence and counseling. LT should be avoided in AH patients that are likely to spontaneously recover. Short- and long-term survival comparable to other indications for LT must be achieved. There should not be further disparity in LT either by indication, geography, or other sociodemographic factors. Treatment of alcohol use disorders should be incorporated into pre and post-LT care. The restrictive and focused evaluation process described in the initial LT experience for AH worldwide may not endure as this indication gains wider acceptance at more LT programs. Transparency in selection process is crucial with collection of objective data to assess outcomes and minimize center variation in listing. Oversight of program adherence is crucial to harmonize listing practices and outcomes.
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影响因子：
9
作者：
Lee, Brian P.;Chen, Po-Hung;Cameron, Andrew M.
通讯作者：
Cameron, Andrew M.
影响因子：
25.7
作者：
Asrani, Sumeet K.;Saracino, Giovanna;Trotter, James
通讯作者：
Trotter, James
影响因子：
13.5
作者：
Lee, Brian P.;Vittinghoff, Eric;Terrault, Norah A.
通讯作者：
Terrault, Norah A.
影响因子：
39
作者：
Lee, Brian P.;Vittinghoff, Eric;Terrault, Norah A.
通讯作者：
Terrault, Norah A.
影响因子：
--
作者：
De Gottardi, Andrea;Spahr, Laurent;Dumortier, Jerome
通讯作者：
Dumortier, Jerome