Transplant Center Attitudes Toward Early Liver Transplant for Alcohol-associated Liver Disease.
Transplant Center Attitudes Toward Early Liver Transplant for Alcohol-associated Liver Disease.
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DOI：
10.1097/txd.0000000000001532
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发表时间：
2023-09
影响因子：
2.3
通讯作者：
中科院分区：
文献类型：
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许多中心已经取消了6个月的移植前戒酒要求，为严重酒精相关性肝病（ALD）患者提供早期肝移植（ELT），但这种做法仍然存在争议。本研究利用一项全国性调查收集的数据，探讨了美国移植中心对英语教学的做法和态度。一项旨在评估中心实践和提供者态度的20项调查通过电子邮件分发给来自143个肝移植中心的225名内科和外科主任。28.9%（n = 65）的主任和39%（n = 56）的移植中心完成了调查。所有响应中心均报告对患者进行ELT评价。考虑ELT的情况包括没有移植的生存期<6个月（96.4%）和移植前不能参加酒精成瘾治疗（75%）。大多数（66%）董事表示，他们的中心已经建立了标准，列出候选人与严重的ALD为ELT。关于ELT候选列表的重要因素，57.1%表示患者存活，37.5%表示移植物存活，55.4%表示复发风险低。只有12.7%的董事肯定了这一说法，“移植前六个月的禁欲降低了复发的风险。”越来越多的中心为严重的ALD提供ELT。不能参加酒精成瘾治疗和<6个月的生存率是考虑ELT的常见情况。对接受ELT的患者移植后结局的持续调查对于建立分配这一宝贵资源的全国共识至关重要。
Many centers have removed 6-mo pretransplant alcohol abstinence requirements to provide early liver transplant (ELT) for individuals with severe alcohol-associated liver disease (ALD), but the practice remains controversial. Using data collected from a nationally distributed survey, this study examines the practices and attitudes of transplant centers in the United States regarding ELT. A 20-item survey designed to assess center practices and provider attitudes was distributed to 225 medical and surgical directors from 143 liver transplant centers via email. Surveys were completed by 28.9% (n = 65) of directors and 39% (n = 56) of transplant centers. All responding centers reported evaluating patients for ELT. Circumstances for considering ELT included <6 mo of survival without a transplant (96.4%) and inability to participate in alcohol addiction therapy pretransplant (75%). Most (66%) directors indicated their center had established criteria for listing candidates with severe ALD for ELT. Regarding important factors for ELT candidate listing, 57.1% indicated patient survival, 37.5% indicated graft survival, and 55.4% indicated having a low risk of relapse. Only 12.7% of directors affirmed the statement, “Six months of pretransplant abstinence decreases the risk of relapse.” More centers are providing ELT for severe ALD. Inability to participate in alcohol addiction therapy and <6 mo of survival are commonly reported circumstances for considering ELT. Continued investigation of posttransplant outcomes in patients receiving ELT is essential to establishing a national consensus for distributing this valuable resource.