Early Liver Transplantation for Severe Alcoholic Hepatitis
Early Liver Transplantation for Severe Alcoholic Hepatitis
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DOI：
10.1056/nejmoa1105703
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发表时间：
2011-11-10
影响因子：
158.5
通讯作者：
Duclos-Vallee, Jean-Charles
中科院分区：
文献类型：
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作者：
Mathurin, Philippe;Moreno, Christophe;Duclos-Vallee, Jean-Charles
在考虑进行肝移植之前，重度酒精性肝炎患者通常需要戒酒6个月。肝炎对药物治疗无反应的患者6个月生存率约为30%。由于大多数酒精性肝炎死亡发生在2个月内，早期肝移植是有吸引力的，但有争议的。患者既往无酒精性肝炎发作，根据里尔模型（计算的评分范围为0 - 1，评分>= 0.45表示对药物治疗无反应，在不进行移植的情况下死亡风险增加）评分为0.45或更高，或尽管接受了药物治疗，肝功能仍迅速恶化。选定的患者也有支持的家庭成员，没有严重的共存条件，并承诺戒酒。比较早期肝移植患者和未早期肝移植患者的生存率。共选择了26例死亡风险高的重度酒精性肝炎患者（中位里尔评分为0.88），在药物治疗无效后中位13天内将其列入肝移植名单。选择了少于2%的因重度酒精性肝炎发作而入院的患者。临床试验机构将2.9%的可用移植物用于该适应症。接受早期移植的患者的6个月累积生存率（+/- SE）高于未接受早期移植的患者（77 +/- 8% vs. 23 +/-8%，P
BACKGROUNDA 6-month abstinence from alcohol is usually required before patients with severe alcoholic hepatitis are considered for liver transplantation. Patients whose hepatitis is not responding to medical therapy have a 6-month survival rate of approximately 30%. Since most alcoholic hepatitis deaths occur within 2 months, early liver transplantation is attractive but controversial.METHODSWe selected patients from seven centers for early liver transplantation. The patients had no prior episodes of alcoholic hepatitis and had scores of 0.45 or higher according to the Lille model (which calculates scores ranging from 0 to 1, with a score >= 0.45 indicating nonresponse to medical therapy and an increased risk of death in the absence of transplantation) or rapid worsening of liver function despite medical therapy. Selected patients also had supportive family members, no severe coexisting conditions, and a commitment to alcohol abstinence. Survival was compared between patients who underwent early liver transplantation and matched patients who did not.RESULTSIn all, 26 patients with severe alcoholic hepatitis at high risk of death (median Lille score, 0.88) were selected and placed on the list for a liver transplant within a median of 13 days after nonresponse to medical therapy. Fewer than 2% of patients admitted for an episode of severe alcoholic hepatitis were selected. The centers used 2.9% of available grafts for this indication. The cumulative 6-month survival rate (+/- SE) was higher among patients who received early transplantation than among those who did not (77 +/- 8% vs. 23 +/- 8%, P