Liver transplantation for alcoholic hepatitis. Current situation and future

Area of Science:

• Hepatology
• Gastroenterology
• Transplantation Medicine

Background:

• Alcoholic hepatitis (AH) is a severe, life-threatening liver disease with high short-term mortality, particularly in severe cases.
• Current treatments for severe AH are limited, with corticosteroids offering only a survival benefit for some patients.
• The Lille score helps identify non-responders to corticosteroids, highlighting the need for alternative therapies.

Purpose of the Study:

• To evaluate the role and challenges of liver transplantation (LT) as a treatment option for severe alcoholic hepatitis (AH).
• To discuss the potential for improving survival in severe AH patients while considering LT indications.

Main Methods:

• Review of current treatment strategies for severe AH, including corticosteroids and the Lille score for response assessment.
• Analysis of the debate surrounding LT for AH, including contraindications like the abstinence rule and concerns about alcohol relapse.
• Examination of survival outcomes and relapse risks in AH patients who have undergone LT.

Main Results:

• Corticosteroids provide a survival benefit in severe AH, but approximately 40% of patients do not respond.
• The 6-month abstinence rule and fear of alcohol relapse pose significant barriers to LT for AH.
• Transplanted AH patients demonstrate improved survival, with no proven increased risk of alcohol relapse.

Conclusions:

• There is a critical need for alternative therapeutic strategies for severe AH non-responsive to corticosteroids.
• Careful patient selection based on strict criteria may allow for successful LT in select AH patients.
• Addressing the challenges associated with LT for AH could improve patient survival without compromising LT for other indications.