Indication of liver transplantation in severe alcoholic liver cirrhosis:: quantitative evaluation and optimal timing
Indication of liver transplantation in severe alcoholic liver cirrhosis:: quantitative evaluation and optimal timing
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DOI：
10.1016/s0168-8278(01)00228-8
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发表时间：
2002-01-01
影响因子：
25.7
通讯作者：
Moirand, R
中科院分区：
文献类型：
--
作者：
Veldt, BJ;Lainé, F;Moirand, R
背景/目的：本研究的目的是评估严重酒精性肝硬化患者需要原位肝移植（奥尔特）的比例，并确定评估戒酒患者移植的最佳延迟时间。方法：对1997年因Child-Pugh C级酒精性肝硬化首次发作而入院的所有患者进行无奥尔特、肝功能改善和奥尔特需求的研究。26%（19/74）的患者在首次住院期间死亡。6个月、1年、2年、3年的累积生存率分别为56%、36%、35%和24%。1例肝移植（1.3%，95%置信区间0.0-3.9）因持续性肝功能衰竭而进行，尽管禁欲。66%的禁欲患者在3个月内观察到Child-Pugh评分改善。奥尔特是指在4例患者没有肝脏改善，尽管禁欲，但禁忌在three.Conclusions：只有少数严重酒精性肝硬化患者进行奥尔特，因为他们中的大多数人不停止饮酒和/或很快死亡，而那些成为禁欲往往改善他们的肝功能。当戒酒3个月后肝功能没有改善时，应考虑进行原位肝奥尔特。(C)2002年欧洲肝脏研究协会。由Elsevier Science B. V.出版，版权所有。
Background/Aims: The aim of our study was to evaluate the proportion of patients with severe alcoholic cirrhosis who would need orthotopic liver transplantation (OLT) and to determine the optimal delay to evaluate an abstinent patient for transplantation.Methods: Survival without OLT, improvement in liver function and need for OLT were studied in all patients admitted in 1997 for a first episode of Child-Pugh C alcoholic cirrhosis.Results: Twenty-six percent (19/74) of patients died during the initial hospitalization. The cumulative survival rates after 6 months and 1, 2 and 3 years were 56, 36, 35 and 24%, respectively. One liver transplantation (1.3%, 95% confidence interval 0.0-3.9) was performed for persisting liver failure despite abstinence. Improvement of the Child-Pugh score was observed within 3 months in 66% of the abstinent patients. OLT was indicated in four patients without liver improvement despite abstinence, but was contraindicated in three.Conclusions: Only a few patients with severe alcoholic cirrhosis undergo OLT, since most of them do not stop drinking and/or die soon, and those becoming abstinent often improve their liver function. OLT should be considered when improvement in liver function is lacking after 3 months of abstinence. (C) 2002 European Association for the Study of the Liver. Published by Elsevier Science B.V. All rights reserved.