Advances and Controversies in Acute Alcohol-Related Hepatitis: From Medical Therapy to Liver Transplantation

Overview

Journal Life (Basel)

Specialty Biology

Date 2023 Sep 28

PMID 37763206

Authors

Giacomo Germani

Francesca DArcangelo

Marco Grasso

Patrizia Burra

Affiliations

Soon will be listed here.

Abstract

Alcohol-related hepatitis (AH) is a clinical syndrome characterized by recent-onset jaundice in the context of alcohol consumption. In patients with severe AH "unresponsive" to steroid therapy, mortality rates exceed 70% within six months. According to European and American guidelines, liver transplantation (LT) may be considered in highly selected patients who do not respond to medical therapy. The aim of this narrative review is to summarize current knowledge from medical therapy to liver transplantation in acute alcohol-related hepatitis. Due to the impossibility to guarantee six-month abstinence, LT for AH is controversial. Principal concerns are related to organ scarcity in the subset of stigma of "alcohol use disorder" (AUD) and the risk of relapse to alcohol use after LT. Return to alcohol use after LT is a complex issue that cannot be assessed as a yes/no variable with heterogeneous results among studies. In conclusion, present data indicate that well-selected patients have excellent outcomes, with survival rates of up to 100% at 24 and 36 months after LT. Behavioral therapy, ongoing psychological support, and strong family support seem essential to improve long-term outcomes after LT and reduce the risk in relapse of alcohol use.

Citing Articles

The impact of socioeconomic deprivation on liver transplantation.

De Simone P, Germani G, Lai Q, Ducci J, Russo F, Gitto S Front Transplant. 2024; 3:1352220.

PMID: 38993752 PMC: 11235234. DOI: 10.3389/frtra.2024.1352220.

Evolution of Liver Transplantation Indications: Expanding Horizons.

Battistella S, Grasso M, Catanzaro E, DArcangelo F, Corra G, Germani G Medicina (Kaunas). 2024; 60(3).

PMID: 38541138 PMC: 10972065. DOI: 10.3390/medicina60030412.

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