Early Liver Transplantation for Severe Alcoholic Hepatitis in the United States—A Single‐Center Experience. Issue 3 (28th December 2015)

• Record Type: Journal Article
• Authors: Im, G. Y.; Kim‐Schluger, L.; Shenoy, A.; Schubert, E.; Goel, A.; Friedman, S. L.; Florman, S.; Schiano, T. D.
• Is Part Of: American journal of transplantation. Volume 16:Issue 3(2016:Mar.)
• Page Start: 841
• Page End: 849
• Publication Date: 2015-12-28
• Subjects: Scope: clinical research/practice -- health services and outcomes research Discipline: liver transplantation/hepatology -- Focus: alcoholism and substance abuse -- liver disease; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ajt.13586
• Languages: English
• ISSNs: 1600-6135

Abstract

Abstract : Early liver transplantation (LT) in European centers reportedly improved survival in patients with severe alcoholic hepatitis (AH) not responding to medical therapy. Our aim was to determine if a strategy of early LT for severe AH could be applied successfully in the United States. We reviewed 111 patients with severe AH at our center from January 2012 to January 2015. The primary end point was mortality at 6 months or early LT, with a secondary end point of alcohol relapse after LT. Survival was compared between those receiving early LT and matched patients who did not. Using a process similar to the European trial, 94 patients with severe AH not responding to medical therapy were evaluated for early LT. Overall, 9 (9.6%) candidates with favorable psychosocial profiles underwent early LT, comprising 3% of all adult LT during the study period. The 6‐month survival rate was higher among those receiving early LT compared with matched controls (89% vs 11%, p<0.001). Eight recipients are alive at a median of 735 days with 1 alcohol relapse. Early LT for severe AH can achieve excellent clinical outcomes with low impact on the donor pool and low rates of alcohol relapse in highly selected patients in the United States. Abstract : In this single‐center experience with the strategy of early liver transplantation for severe alcoholic hepatitis in the United States, clinical outcomes are excellent, with increased six‐month survival, low impact on the donor pool, and low rates of alcohol relapse in highly selected recipients. See the editorial from Lucey and Rice onpage 739 .