Three-year Results of a Pilot Program in Early Liver Transplantation for Severe Alcoholic Hepatitis
Three-year Results of a Pilot Program in Early Liver Transplantation for Severe Alcoholic Hepatitis
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DOI：
10.1097/sla.0000000000001831
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发表时间：
2017-01-01
影响因子：
9
通讯作者：
Cameron, Andrew M.
中科院分区：
文献类型：
--
作者：
Lee, Brian P.;Chen, Po-Hung;Cameron, Andrew M.
目的：检查我们于 2012 年 10 月启动的对选定的急性酒精性肝炎患者进行移植的试点。背景：肝移植前通常需要六个月戒酒。法国-比利时协议显示，严重酒精性肝炎的早期移植可以提高生存率，并且酒精复发率较低。尽管普遍性尚不清楚，但这一有争议的适应症的应用正在不断增长。方法：收集了自试点开始至 2015 年 6 月期间所有患有酒精相关肝病的患者的数据。患者被分为两组：首先出现肝脏失代偿的严重酒精性肝炎（第 1 组），戒酒时间≥6 个月的酒精性肝硬化（第 2 组）。酒精复发被定义为移植后任何饮酒的证据，并评估是否存在有害的暴饮暴食或频繁饮酒模式。 结果：43 名患者接受了肝移植，其中第 1 组中有 17 名患者。第 1 组和第 2 组的六个月生存率分别为 100% 和 89% (P = 0.27)。第 1 组与第 2 组的酒精复吸率相似：23.5% 与 29.2%（P > 0.99）。尽管缺乏统计学意义，但第 1 组与第 2 组的有害饮酒率较高：23.5% 与 11.5% (P = 0.42)。 结论：在这项精心挑选的患者试点中，早期肝移植提供了极好的短期生存率，与戒酒 6 个月的患者相比，酒精复发率相似。在这一人群中，有害的复发模式仍然具有挑战性，这凸显了需要经过验证的模型来预测酒精复发，并且在选择患有这种特殊适应症的患者时需要极其谨慎。需要进行更大规模的前瞻性研究和更长时间的随访。
Objective: To examine our pilot to transplant selected patients with acute alcoholic hepatitis, initiated in October 2012.Background: Six months of alcohol abstinence is typically required before liver transplant. A Franco-Belgian protocol showed that early transplant in severe alcoholic hepatitis could improve survival with low incidence of alcohol relapse. Application of this controversial indication is growing despite unclear generalizability.Methods: Data was collected on all patients with alcohol-related liver disease since initiation of the pilot through June 2015. Patients were stratified into two groups: severe alcoholic hepatitis as first liver decompensation (Group 1), alcoholic cirrhosis with >= 6 months abstinence (Group 2). Alcohol relapse was defined as any evidence of alcohol consumption after transplant, which was assessed for harmful patterns of binge or frequent drinking.Results: Forty-three patients underwent liver transplant, including 17 patients in Group 1. Six-month survival was 100% versus 89% for Groups 1 and 2, respectively (P = 0.27). Alcohol relapse was similar in Group 1 versus Group 2: 23.5% versus 29.2% (P > 0.99). Harmful drinking was higher in Group 1 versus Group 2, despite lack of statistical significance: 23.5% versus 11.5% (P = 0.42).Conclusions: In this pilot with carefully selected patients, early liver transplant provided excellent short-term survival, and similar rates of alcohol relapse compared with patients with 6 months of abstinence. Harmful patterns of relapse remain challenging in this population, highlighting the need for validated models to predict alcohol relapse, and need for extreme caution in selecting patients for this exceptional indication. Larger prospective studies and longer follow up are necessary.