before they can be considered for the procedure. One of the reasons for this is
to make sure that they do not resume alcohol use after the transplantation.Patients
whose alcoholic hepatitis is not responding to medical therapy have a 6-month
survival rate of approximately 30%. Since most alcoholic hepatitis deaths occur
within 2 months, early liver transplantation could save lives.
Glucocorticoids
are generally administered to patients with severe alcoholic hepatitis but if
they do not respond then early liver transplantation remains the only option.
It is during these times that the six-month waiting period becomes
controversial.
Aims
The aims
of a study published in the New England Journal of Medicine include:
To
determine if early liver transplantation in patients with severe alcoholic
hepatitis (unresponsive to treatment) is able to improve the 6-month survival
rate
To
evaluate the rate at which alcohol relapse occurred in patients selected
without the 6 months abstinence criteria
Methods
Patients were selected from seven centers and listed
for early liver transplantation within 13 days (approx.) of being unresponsive
to therapy.
The
patients did not have alcoholic hepatitis earlier and scored 0.45 or higher
according to the
Lille model (a
scale that evaluates severity of liver disease and risk of death if
transplantation is not carried out), placing them on the high-risk
category.
Survival
rate was compared between patients on whom early liver transplantation was
carried out and similar patients who did not have an early transplantation.
The
patients selected for study were committed to
alcohol abstinence and
provided
informed consent for surgery.
Patients
who were unaware of their underlying problem were given preference over others.
Those with more than one episode of alcoholic hepatitis were excluded from the
study.
The study
was approved by the Scientific committees from the Association Française
d'Etude du Foie, the Association Française de Chirurgie Hépato-Biliaire et de
Transplantation, and the Agence de Biomédecine, which are all agencies of the
French government in charge of graft allocation.
Results
The 6-month survival rate was notably higher
among patients undergoing transplantation than among controls. The benefits of
early transplantation were maintained for the 2 years of follow up. Only 3
patients resumed drinking alcohol during the follow-up period.
Choosing the time of transplantation was crucial,
as any intervention that was too late or too early had adverse effects.
The study
challenges the requirement of an abstinence period prior to transplantation and
confirms that early liver transplantation
can improve survival rate in
patients with a first episode of severe alcoholic hepatitis that is
unresponsive to medical therapy.
More
studies are required to substantiate these results.
Reference:
1. Philippe Mathurin, M.D., Ph.D., Christophe Moreno, M.D., Ph.D.,
Didier Samuel, M.D., Ph.D., et al. Early Liver Transplantation for Severe Alcoholic Hepatitis. N Engl J Med 2011; 365:1790-1800 November.10, 2011
Source: Medindia
