Selective Use of Liver Transplantation for Severe Alcohol-Associated Hepatitis.

Selective Use of Liver Transplantation for Severe Alcohol-Associated Hepatitis. Expert Rev Gastroenterol Hepatol. 2020 Feb 20;: Authors: Ayyala-Somayajula D, Han H, Terrault NA Abstract Introduction: Severe alcohol-associated hepatitis (sAH) portends high morbidity and mortality and there are no effective therapies for those ineligible or unresponsive to corticosteroids. Early liver transplantation (LT), defined as transplant without a mandated period of sobriety, for sAH, is being increasingly considered as a rescue therapy.Areas covered: PubMed and manual searches were combined and last performed on October 28th 2019. Key search terms were "alcoholic hepatitis", "abstinence", "alcohol relapse", and "liver transplantation". Terms were combined within each database. General reviews and references from published trials were also used.Expert opinion: Early LT is indicated in highly selected patients with sAH. While long-term data are sparse, 1 and 3-year survival post-transplantation are excellent and comparable to other liver diseases. Alcohol relapse is uncommon but approaches 10-25% at 3 years and if use is heavy and/or sustained leads to reduced survival. Thus, for continued application of transplant for this indication, there is a need to further refine selection criteria and to optimize management of alcohol use disorder (AUD) in the transplant setting. Integral to advancing these objectives is the elimination of societal stigmat...
Source: Expert Review of Gastroenterology and Hepatology - Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research