Liver transplant evaluation redux: Hope for reconsidering previously declined candidates with alcohol-associated liver disease.
Liver transplant evaluation redux: Hope for reconsidering previously declined candidates with alcohol-associated liver disease.
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肝移植评估重做：希望重新考虑之前拒绝的患有酒精相关肝病的候选人。
DOI：
10.1097/lvt.0000000000000295
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发表时间：
2024
期刊：
影响因子：
--
通讯作者：
Mellinger,JessicaL
中科院分区：
文献类型：
--
作者：
Winder,GeraldScott;Mellinger,JessicaL
酒精相关性肝病（ALD）是酒精使用障碍（AUD）的一种严重医学表现，它仍然是全球死亡率的主要来源，也是肝移植（LT）的主要适应症，特别是在年轻人中。[1]LT中的酒精危害不仅限于ALD诊断的患者;至少29%和25%的非酒精相关脂肪性肝病和代谢功能障碍相关脂肪性肝病患者分别被发现存在酒精相关肝损伤的风险。[2]鉴于肝脏的短缺和保持良好临床结果的重要性，LT中心有义务提高其酒精评估和治疗方法的复杂性;他们采用异质性方法来实现这一目标。[3] AUD的各种因素及其频繁的心理社会共病导致ALD候选人最初不符合LT上市的可能性很高。[4]AUD通常是一种严重的复发性疾病，其特征是先前的治疗尝试不成功。危险的酒精使用可能会破坏自我护理，医疗依从性和住房等基本需求。其他慢性精神疾病和危险物质使用模式是常见的合并症。家庭、婚姻和伴侣关系往往受到严重损害。洞察力的缺陷可能会损害一个人承认酒精相关问题和充分参与AUD治疗的能力。长期的酒精相关的欺骗习惯使自我报告的物质使用在LT评估过程中不可靠。[5]这些实质性的心理社会风险和障碍存在于ALD人群中，他们的护理通常在不同的医学和心理社会专业中脱节，并且与没有ALD的患者相比，他们更有可能出现晚期医学疾病。[6]美国
Alcohol-associated liver disease (ALD) is a severe medical manifestation of alcohol use disorder (AUD), which remains a major source of global mortality and a leading indication for liver transplantation (LT), particularly among younger adults.[1] Alcohol hazards in LT are not just confined to those patients with ALD diagnoses; at least 29% and 25% of patients diagnosed with nonalcohol-related fatty liver disease and metabolic dysfunction–associated steatotic liver disease, respectively, have been found to be at risk of alcoholassociated liver damage.[2] Given the shortage of livers and the importance of maintaining favorable clinical outcomes, LT centers are obliged to increase the sophistication of their alcohol evaluation and treatment methods; they employ heterogenous approaches in doing so.[3]Various elements of AUD and its frequent psychosocial comorbidities create a high probability that candidates with ALD will not initially qualify for LT listing.[4] AUD is often a severe, relapsing condition marked by previous unsuccessful treatment attempts. Hazardous alcohol use may disrupt self-care, medical adherence, and basic needs like housing. Other chronic psychiatric disorders and risky substance use patterns are common comorbidities. Family, marital, and partner relationships are often severely damaged. Deficits in insight might impair a person’s ability to acknowledge alcohol-associated problems and adequately engage in AUD treatment. Longstanding habits of alcohol-associated deception make self-reported substance use unreliable during LT evaluation.[5] These substantial psychosocial risks and barriers exist in a population with ALD whose care is often disjointed across disparate medical and psychosocial specialties and who are more likely to present with advanced medical disease compared with patients without ALD.[6]