Management of alcohol use disorder in patients with cirrhosis in the setting of liver transplantation.
Management of alcohol use disorder in patients with cirrhosis in the setting of liver transplantation.
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DOI：
10.1038/s41575-021-00527-0
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发表时间：
2022-01
期刊：
影响因子：
--
通讯作者：
Shah VH
中科院分区：
文献类型：
--
作者：
Arab JP;Izzy M;Leggio L;Bataller R;Shah VH
酒精使用障碍（AUD）的患病率在过去十年中一直在稳步上升。与此同时，酒精相关性肝病（ALD）正在以惊人的速度增加，特别是在年轻患者中。数据表明，大多数ALD患者未接受AUD治疗。虽然肝移植是终末期ALD的唯一治愈性疗法，但考虑到对患者治疗不足的担忧以及对移植后复发影响同种异体移植物的担忧，移植候选人资格往往是一个有争议的问题。在这篇综述中，我们讨论了诊断，预测因素和复发的影响，行为疗法和药物疗法，我们还提出了一个综合的，多学科的和多模式的方法来治疗肝硬化患者的AUD，特别是在肝移植的背景下。值得注意的是，这种方法考虑了AUD药物治疗在接受免疫抑制药物治疗的患者和肝移植后肾损害患者中的效用。我们还提出了一个全面和客观的定义复发利用当代生物标志物，以指导未来的临床试验。未来的研究使用所提出的方法和定义是必要的，目标是优化肝硬化患者的AUD治疗，移植选择过程和AUD患者的移植后护理。在这篇综述中，Arab及其同事讨论了酒精相关性肝病患者酒精使用障碍的管理，特别是在肝移植的情况下。提出了一种综合的、多学科的方法。酒精使用障碍（AUD）和酒精相关性肝病的患病率在过去几十年中在全球范围内有所增加。肝移植后复发的定义有很大不同。目前，我们对肝移植术后复发的预测因素和影响的理解正在增长，并结合多学科方法可能会改善患者的预后。在调整治疗方案以考虑合并症（如肾功能不全）后，在肝硬化患者中使用药物治疗AUD是可行的。复发预防药物与肝移植后常用的免疫抑制剂没有明显的相互作用。将药物和行为治疗与移植中心的医疗护理相结合，可能会最大限度地发挥预防复发的潜力。
The prevalence of alcohol use disorder (AUD) has been steadily increasing over the past decade. In parallel, alcohol-associated liver disease (ALD) has been increasing at an alarming rate, especially among young patients. Data suggest that most patients with ALD do not receive AUD therapy. Although liver transplantation is the only curative therapy for end-stage ALD, transplant candidacy is often a matter of debate given concerns about patients being under-treated for AUD and fears of post-transplantation relapse affecting the allograft. In this Review, we discuss diagnosis, predictors and effects of relapse, behavioural therapies and pharmacotherapies, and we also propose an integrative, multidisciplinary and multimodality approach for treating AUD in patients with cirrhosis, especially in the setting of liver transplantation. Notably, this approach takes into account the utility of AUD pharmacotherapy in patients on immunosuppressive medications and those with renal impairment after liver transplantation. We also propose a comprehensive and objective definition of relapse utilizing contemporary biomarkers to guide future clinical trials. Future research using the proposed approach and definition is warranted with the goal of optimizing AUD treatment in patients with cirrhosis, the transplant selection process and post-transplantation care of patients with AUD. In this Review, Arab and colleagues discuss management of alcohol use disorder in patients with alcohol-associated liver disease, particularly in the setting of liver transplantation. An integrative, multidisciplinary approach is proposed. The prevalence of alcohol use disorder (AUD) and alcohol-associated liver disease has increased over the past few decades globally. Definitions of relapse after liver transplantation vary widely. Currently, our understanding of the predictors and effects of relapse after liver transplantation is growing and together with a multidisciplinary approach might improve patient outcomes. The use of pharmacotherapies for AUD is feasible in patients with cirrhosis after tailoring the regimen to account for comorbid illnesses such as renal dysfunction. Relapse-prevention medications do not have notable interactions with immunosuppressants commonly used after liver transplantation. Combining medications and behavioural treatments with medical care at the transplant centre might maximize relapse prevention potential.
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DOI：
10.1111/acer.14512
发表时间：
2021-01
期刊：
Alcoholism, clinical and experimental research
影响因子：
--
作者：
Arnts J;Vanlerberghe BTK;Roozen S;Crunelle CL;Masclee AAM;Olde-Damink SWM;Heeren RMA;van Nuijs A;Neels H;Nevens F;Verbeek J
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影响因子：
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1.9
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Björnsson, E;Olsson, J;Friman, S
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Friman, S
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39
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Bristol, Emily
影响因子：
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