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Published on: August 17, 2022
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Liver transplantation for severe alcoholic hepatitis: A multicenter Italian study
Giacomo Germani1, Debora Angrisani2, Giovanni Addolorato3,4
1Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy.
Summary
Early liver transplantation (eLT) significantly improves survival for severe alcoholic hepatitis (sAH) patients unresponsive to medical therapy. Strict patient selection is crucial for successful eLT outcomes in sAH.
Area of Science:
- Hepatology
- Transplantation Medicine
- Gastroenterology
Background:
- Severe alcoholic hepatitis (sAH) poses a significant challenge in liver disease management.
- Early liver transplantation (eLT) is increasingly recognized as a viable treatment option for select sAH patients.
- Standardized protocols for eLT in sAH are being developed to optimize patient outcomes.
Purpose of the Study:
- To evaluate the outcomes of early liver transplantation (eLT) for severe alcoholic hepatitis (sAH) across four Italian centers.
- To compare the survival rates of eLT recipients with patients suffering from sAH who did not respond to medical therapy and were excluded from transplantation.
- To assess the long-term post-transplant survival and the rate of alcohol relapse in patients who underwent eLT for sAH.
Main Methods:
- A retrospective analysis of patients admitted for sAH between 2013 and 2019, adhering to NIAAA criteria.
- Patients unresponsive to medical therapy were rigorously selected for the liver transplant (LT) waiting list.
- Evaluation of explanted liver histology, post-transplant survival rates, and alcohol consumption recurrence.
Main Results:
- Out of 93 evaluated sAH patients, 16 underwent early liver transplantation (eLT).
- eLT recipients demonstrated significantly higher 6-, 12-, and 24-month survival rates (100%) compared to non-responders denied LT (45%, 45%, 36%; p < .001).
- Alcohol relapse occurred in 2 out of 16 eLT patients (12.5%) within approximately six months post-transplant.
Conclusions:
- Early liver transplantation (eLT), when applied with strict patient selection, significantly enhances survival in severe alcoholic hepatitis (sAH) patients unresponsive to medical therapy.
- The study highlights the efficacy of eLT in improving survival for a carefully selected sAH cohort.
- Further research is warranted to comprehensively evaluate alcohol relapse rates and long-term outcomes following eLT for sAH.
