Liver transplantation for patients with alcoholic hepatitis
Liver transplantation for patients with alcoholic hepatitis
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DOI：
10.1111/liv.13248
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发表时间：
2017-03-01
影响因子：
6.7
通讯作者：
Mathurin, Philippe
中科院分区：
文献类型：
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作者：
Artru, Florent;Louvet, Alexandre;Mathurin, Philippe
酒精性肝病被认为是一种自我感染的疾病，是道德判断如何影响医学伦理实践的一个例子，这需要在器官短缺的情况下公平和公正地利用稀缺资源。一些人认为，选择过程应优先考虑非因自身过错而发生肝衰竭的患者接受肝移植（LT），即使由于患者认为的责任而限制护理被认为是不道德的。由于戒酒后没有改善、短期死亡风险高以及对药物治疗无反应的 AH 患者 LT 后 6 个月饮酒复发规则的可预测性较差，因此建议对 LT 进行评估。在法国-比利时试点研究中，26 名对药物治疗无反应的严重 AH 患者接受了早期 LT (eLT)。采用了严格的选择标准。 eLT 患者的 6 个月和 2 年生存率优于非移植匹配对照：分别为 77% vs 23% 和 71% vs 23%。 eLT 后 12% 的患者出现酒精复发。三项研究证实了这些结果。最近的一项调查显示，应限制有影响的器官捐献，并应根据科学数据和医学伦理开展公共宣传活动。总之，科学证据的不断积累和医学伦理实践的要求导致继续评估 eLT 作为对药物治疗无反应的严重 AH 患者的治疗选择。
Alcoholic liver disease, considered as a self-inflected disease, is an example of how moral judgment may affect ethical exercise of medicine which requires equity and fair utilization of a scarce resource in a context of organ shortage. Some consider that selection process should prioritize access to liver transplantation (LT) for patients who develop liver failure through no fault of their own even if limiting care because of a patient's perceived responsibility has been considered unethical. The absence of improvement after alcohol withdrawal, the high short-term mortality risk and the poor predictability of the 6-month rule in post-LT relapse in alcohol consumption in AH patients not responding to medical therapy led to recommend an evaluation of LT. In the French-Belgian pilot study, 26 patients with severe AH not responding to medical therapy underwent early LT (eLT). Stringent selection criteria were applied. Six-month and 2-year survivals of eLT patients were better than that of non-transplanted matched controls: 77% vs 23% and 71% vs 23% respectively. Alcohol relapse occurred in 12% of patients after eLT. Three studies confirmed these results. The impact organ donation should be limited as showed by a recent survey and the efforts that should be made in public information campaigns based on scientific data and medical ethics. In conclusion, the ongoing accumulation of scientific evidence and requirement of ethical exercise of medicine lead to continue evaluating eLT as a therapeutic option in patients with severe AH not responding to medical therapy.