Transplant in acute alcoholic hepatitis: a relative contraindication

Area of Science:

• Hepatology
• Transplantation Medicine
• Addiction Psychiatry

Background:

• Alcohol-associated liver disease is a growing reason for liver transplantation in the USA.
• Acute alcoholic hepatitis is increasingly diagnosed in younger individuals and carries a high mortality risk.
• Liver transplantation can yield excellent results for alcoholic hepatitis but faces implementation challenges.

Purpose of the Study:

• To critically analyze liver transplantation for alcoholic hepatitis.
• To identify barriers to long-term success in current US implementation strategies.

Main Methods:

• Review of current literature on liver transplantation for alcoholic hepatitis.
• Analysis of implementation strategies and associated challenges.

Main Results:

• Excellent outcomes are achievable with liver transplantation for alcoholic hepatitis.
• Key barriers include risk of allograft dysfunction, viewing alcohol use disorder as a multisystem disease, and ethical considerations.
• Liver transplantation is not yet standard care but a viable option for carefully selected patients.

Conclusions:

• Liver transplantation is a critical option for select alcoholic hepatitis patients.
• National policy changes require consistency, transparency, and consensus.
• Post-transplant wraparound services are essential for relapse prevention and long-term survival.