Clin Mol Hepatol.  2018 Mar;24(1):43-50. 10.3350/cmh.2017.0027.

Role of liver transplantation in severe alcoholic hepatitis

Affiliations
  • 1Institute of Liver, Gastroenterology, & Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, New Delhi, India. ashishk10@yahoo.com

Abstract

Severe alcoholic hepatitis has very high short term mortality and corticosteroids have been the mainstay of treatment for decades. Patients with Lille score >0.45 are considered non-responders to steroids and have poor outcome. Recently Orthotopic Liver Transplantation (OLT) is being increasingly used as rescue treatment for these patients, without waiting for 6 months of abstinence. Liver transplant is the only rescue treatment which can potentially provide long term benefit for patients who are steroid non-responders. However, with scarcity of organs being a concern, all patients of severe alcoholic hepatitis cannot be chosen for transplantation in an arbitrary way. There is a need for development of predictive tools and objective protocols to select patients who can justify the use of precious liver grafts. With a stringent criteria for selection of patients receiving the graft, liver transplantation in severe alcoholic hepatitis can become a viable rescue therapeutic option conferring significant survival advantage of both short- and long-term basis. The optimal criteria for selection will also prevent misuse of the liver donor pool as well as to prevent mortality in salvageable patients. Further research needs to be done to identify subset of patients which are at low risk of recidivism and also cannot be managed with pharmacotherapy alone. We reviewed the current knowledge on role of OLT in patient with acute severe alcoholic hepatitis in the present review.

Keyword

Alcoholic hepatitis; Cirrhosis; Liver transplantation; Alcoholic liver disease

MeSH Terms

Adrenal Cortex Hormones
Alcoholics*
Drug Therapy
Fibrosis
Hepatitis, Alcoholic*
Humans
Liver Diseases, Alcoholic
Liver Transplantation*
Liver*
Mortality
Steroids
Tissue Donors
Transplants
Adrenal Cortex Hormones
Steroids
Full Text Links
  • CMH
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr