Reply to ''Alcohol and Liver Transplantation''.
Reply to ''Alcohol and Liver Transplantation''.
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回复“酒精与肝脏移植”。
DOI：
10.1093/alcalc/agw057
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发表时间：
2017
期刊：
影响因子：
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通讯作者：
Singal,AshwaniK
中科院分区：
文献类型：
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作者：
Russ,KirkB;Chen,Nai-Wei;Kamath,PatrickS;Shah,VijayH;Kuo,Yong-Fang;Singal,AshwaniK
我们感谢 Testino 博士和 Leone 博士对我们在最近一期《酒精和酒精中毒》中发表的题为“肝移植后饮酒与肝病病因无关”的手稿感兴趣（Russ 等人，2016 年）。我们饶有兴趣地阅读了这封信，并同意他们的评论，即担心接受肝移植的患者因移植后饮酒而患上非酒精性脂肪肝和恶性肿瘤的风险更高。肝移植后的饮酒轨迹因移植后发病时间、饮酒模式（间歇性与连续性）和饮酒量（轻度、中度或有害）而异（DiMartini 等，2010；Russ 等，2016）。我们同意作者的观点，即根据国家酒精滥用和酒精中毒研究所的定义，识别男性每天饮酒超过 2 杯、女性每天饮酒超过 1 杯的累犯非常重要，因为这些患者仍然面临移植肝硬化的风险，且长期随访生存率较差（Singal 等人，2013 年）。移植后有害饮酒患者的中位随访时间相对较短且样本量较小，这可能是我们的研究中缺乏类似观察结果的原因（Russ 等，2016）。广泛使用简单、准确的饮酒筛查工具，如 CAGE 和酒精使用障碍识别测试，可以在移植前和移植后识别出有害饮酒的患者。然后可以针对这些人进行旨在减少饮酒的行为和/或药物干预。尿或头发乙基葡萄糖醛酸水平和尿磷脂酰乙醇等新兴生物标志物在预测饮酒量方面更准确，有望有助于肝移植候选者的选择及其移植后结果（Singal 等，2013）。
We thank Drs Testino and Leone for their interest in our manuscript publication entitled ‘Alcohol use after liver transplantation is independent of liver disease etiology’in the recent issue of Alcohol and Alcoholism (Russ et al., 2016). We read with interest the letter and agree on their comment regarding concern for higher risk for development of non-alcoholic fatty liver disease and malignancy with post-transplant alcohol use among patients undergoing liver transplantation. Trajectories on alcohol use after liver transplantation vary in terms of time to onset after transplantation, pattern of alcohol use (intermittent vs. continuous) and amount of alcohol use (light, moderate or harmful)(DiMartini et al., 2010; Russ et al., 2016). We agree with the authors that it is important to identify recidivists with harmful use of alcohol of> 2 drinks per day in men and> 1 drink per day in women as defined by the National Institute on Alcohol Abuse and Alcoholism, as these patients remain at risk for graft cirrhosis with worse survival on long-term follow-up (Singal et al., 2013). Relatively shorter median follow and small sample size of patients with harmful post-transplant alcohol use are likely reasons for lack of similar observation in our study (Russ et al., 2016). Widespread use of simple accurate screening tools of alcohol consumption such as CAGE and Alcohol use disorder identification test can identify patients with harmful alcohol use both pretransplantation as well as post-transplantation. These individuals can then be targeted for behavioral and/or pharmacological interventions aiming to reduce alcohol consumption. Emerging biomarkers such as urinary or hair ethyl glucuronide levels and urinary phosphatidylethanol are more accurate in predicting alcohol consumption and will hopefully help in candidate selection for liver transplantation and their post-transplant outcomes (Singal et al., 2013).