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Controversies in early liver transplantation for severe alcoholic hepatitis.
Wu, Tiffany; Morgan, Timothy R; Klein, Andrew S; Volk, Michael L; Saab, Sammy; Sundaram, Vinay.
Afiliação
  • Wu T; Department of Medicine, Division of Gastroenterology and Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
  • Morgan TR; Department of Veterans Affairs, VA Long Beach Healthcare System, Long Beach, CA, Division of Gastroenterology, University of California, Irvine, CA, USA.
  • Klein AS; Department of Surgery and Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
  • Volk ML; Division of Gastroenterology and Transplantation Institute, Loma Linda University, Loma Linda, CA, USA.
  • Saab S; Division of Digestive Diseases and Pfleger Liver Institute, University of California, Los Angeles, CA, USA.
Ann Hepatol ; 17(5): 759-768, 2018 Aug 24.
Article em En | MEDLINE | ID: mdl-30145578
Alcoholic hepatitis (AH) is a condition of acute liver inflammation in the setting of heavy alcohol use that is often managed with corticosteroids in severe cases. Among non-responders to steroids, however, prognosis is poor with up to 75% mortality within 6 months after treatment failure. Early liver transplantation (LT) can achieve an acceptable short-term survival, and initial studies have demonstrated 3-year survival rates of up to 84%. However, the practice of early LT in severe AH remains controversial with concerns over the 6-month rule of sobriety and risk of alcohol relapse post-transplant. Proponents of LT advocate for better understanding of alcohol use as a disorder rather than self-inflicted cause of illness, aim to redefine the misguided application of the 6-month rule, and point out similar relapse rates among patients with early LT and those with greater than 6 months abstinence before transplant. Opponents of LT emphasize the correlation between alcohol relapse and graft failure and mortality, public resistance and potential for distrust among donors, and arguments that transplant centers need to establish improved models to predict relapse and standardize candidate selection criteria across centers. Here we review recent literature on this controversy and provide recommendations for moving forward to consensus.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Transplante de Fígado / Hepatite Alcoólica Tipo de estudo: Diagnostic_studies / Etiology_studies / Guideline / Prognostic_studies / Risk_factors_studies Limite: Humans Idioma: En Revista: Ann Hepatol Assunto da revista: GASTROENTEROLOGIA Ano de publicação: 2018 Tipo de documento: Article País de afiliação: Estados Unidos País de publicação: México

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Transplante de Fígado / Hepatite Alcoólica Tipo de estudo: Diagnostic_studies / Etiology_studies / Guideline / Prognostic_studies / Risk_factors_studies Limite: Humans Idioma: En Revista: Ann Hepatol Assunto da revista: GASTROENTEROLOGIA Ano de publicação: 2018 Tipo de documento: Article País de afiliação: Estados Unidos País de publicação: México