Liver Transplantation for Severe Alcoholic Hepatitis: Report of a Single Center Pilot Program
| Autor: | Tsuyoshi Todo, C. Galloway, Tiffany Wu, Nicholas N. Nissen, Vinay Sundaram, Walid S. Ayoub, Andrew S. Klein, A.L. Christianson, Mazen Noureddin, I. Kim |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Alcoholic hepatitis Pilot Projects 030204 cardiovascular system & hematology 030230 surgery Liver transplantation Single Center 03 medical and health sciences 0302 clinical medicine Sobriety Recurrence Internal medicine medicine Humans Survival rate Retrospective Studies Hepatitis Transplantation Alcohol Abstinence Hepatitis Alcoholic business.industry Patient Selection Retrospective cohort study Middle Aged medicine.disease Liver Transplantation Survival Rate surgical procedures operative Female Surgery business |
| Zdroj: | Transplantation Proceedings. 50:3527-3532 |
| ISSN: | 0041-1345 |
| DOI: | 10.1016/j.transproceed.2018.08.057 |
| Popis: | Background Liver transplantation (LT) can significantly improve mortality for severe alcoholic hepatitis (AH). However, this practice remains controversial. Our aim is to report the findings from our institution regarding outcomes for LT in severe AH and to discuss the results of a pilot program for discharging selected patients with close follow-up, in order to demonstrate sustained outpatient sobriety before listing. Methods Patient records were reviewed retrospectively from January 1, 2015 to January 17, 2018. The primary outcomes were patient and graft survival after LT. Secondary outcomes included relapse rates after LT, survival for those not transplanted, and reasons for denial among those not approved for transplant listing. Results A total of 18 patients with severe AH were considered for LT, of which 10 were transplanted and 8 were either denied transplantation or died before completing the evaluation. Patient and graft survival rates were 100% among those transplanted, and only 1 of the 10 patients (10%) returned to harmful drinking. In comparison, 6 of 8 (75%) of patients not transplanted died. Among the 10 patients transplanted, 4 were initially not approved for listing and were discharged with close follow-up, to demonstrate outpatient sobriety. All 4 of those patients demonstrated short-term abstinence and ultimately underwent transplantation, with no instances of relapse post-LT. Conclusions Liver transplantation for AH can achieve excellent outcomes with low rates of relapse. Carefully selected patients can be discharged with close monitoring to demonstrate commitment to outpatient sobriety prior to transplant listing. |
| Databáze: | OpenAIRE |
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