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Liver transplantation for severe alcoholic hepatitis– The PRO view
Author(s) -
Lucey Michael R.
Publication year - 2017
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.13343
Subject(s) - alcoholic hepatitis , liver transplantation , medicine , alcoholic liver disease , alcohol use disorder , abstinence , transplantation , liver disease , alcohol dependence , disease , alcohol abuse , hepatitis , hepatitis c , intensive care medicine , psychiatry , cirrhosis , alcohol , biochemistry , chemistry
Abstract Although liver transplantation has become accepted as a life‐saving treatment of last resort for most life‐threatening liver disorders, the use of liver transplantation to rescue patients with severe alcoholic hepatitis unresponsive to medical therapy remains controversial. I propose the concepts that alcohol use disorder is an illness, that on occasion results in alcoholic liver disease and that treatment of alcoholic liver disease, including treatment of patients with severe alcoholic hepatitis, combines treatment of the alcohol use disorder and of alcoholic liver disease. From this I derive the following principal to govern selection of patients for liver transplantation of patients with alcohol use disorder: that alcohol use disorder should impact suitability for liver transplantation as a co‐morbid disorder, in the same way as other common co‐morbid disorders such as diabetes mellitus or systemic hypertension, are factored in the selection process. We should relate the risk of drinking relapse to the prognosis of the patient after transplantation, rather than in a binary construct of likelihood of maintaining abstinence vs drinking.