Is alcoholic hepatitis an indication for transplantation? Current management and outcomes

Authors

  • Philippe Mathurin

    Corresponding author
    1. Service d'Hépatogastroentérologie Hôpital Claude Huriez and Equipe mixte INSERM 0114, CHU Lille, France
    • Service d'Hépatogastroentérologie, Hôpital Claude Huriez 2ème étage Est, Avenue Michel Polonovski, CHRU Lille 59037, France
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    • Phone: (33) 3 20-44-55-97; FAX: (33) 3 20-44-55-64


Abstract

Key Points

  • 1In the absence of treatment, 50% of patients with severe alcoholic hepatitis (AH) [Maddrey function (DF) ≥ 32] die 2 months later. Among patients with severe AH treated by corticosteroids, 80% had 2-month survival. Pentoxifylline is considered by some investigators to be an alternative option to corticosteroids.
  • 2Non-responders to corticosteroids (NRCs) have poor survival and require new strategies. Liver transplantation should be considered in order to improve survival of non-responders to therapeutic agents.
  • 3Prognostic models such as the Model for End-Stage Liver Disease (MELD) and DF are useful tools for predicting short-term mortality of patients with severe AH. Specific models taking into account the particular settings of treated patients are warranted.
  • 4In an era of organ shortage, use of liver transplants in patients with severe AH may negatively affect the public attitude on transplantation and organ donation, and may cause reluctance on the part of clinicians to modify guidelines for alcoholic patients.
  • 5Therefore, a reasonable approach would be to carry out only pilot studies on only a small cohort of patients to determine whether transplantation improves survival in patients with severe AH. (Liver Transpl 2005;11:S21–S24.)

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