More with acute alcoholic hepatitis receiving liver transplants

Last Updated: 2018-09-03

By Anne Harding

NEW YORK (Reuters Health) - More patients with severe acute alcoholic hepatitis (SAH) are receiving early liver transplants (LTs), new research shows.

Twenty-seven U.S. centers were registering SAH patients to their LT wait lists in 2016, up from 10 in 2011, while the annual number of LT wait list registrants with SAH rose from 14 to 58 over the same time period, Dr. George Cholankeril of Stanford University School of Medicine and colleagues report in Alcohol and Alcoholism, online August 7.

Conventional wisdom has held that SAH patients should remain sober for at least six months before they can be candidates for LT, Dr. Cholankeril told Reuters Health by phone. But many SAH patients don't present for care until they have severe inflammatory disease, he added.

"When these patients become too sick, it becomes difficult to see if they are candidates for liver transplantation," Dr. Cholankeril said.

He and his colleagues looked at United Network for Organ Sharing data from 2011 to 2016 on 186 SAH patients newly listed for liver transplant and 931 patients with acute liver failure due to drug-induced liver injury, who were divided into acetaminophen (APAP, n=241) and non-APAP (n=690) groups.

Median Model for End-Stage Liver Disease (MELD) score was 32 with SAH, 34 with APAP and 21 with non-APAP. Liver transplants were performed in 67.7% of SAH patients, 36.3% of APAP patients and 58.2% of non-APAP patients.

Median time to transplant was 10 days with SAH, three with APAP and 45 with non-APAP. One-year post-transplant survival was 89.5% with SAH, 87.7% with APAP and 90.9% with non-APAP, while three-year survival was 87.8%, 77.4% and 85.9%, respectively.

"These observations further support the recommendations of experts to refer carefully selected SAH patients with MELD score >26 who fail medical therapy for a comprehensive evaluation for early liver transplantation due to high overall mortality rate if managed conservatively," Dr. Cholankeril and his colleagues write.

"Early referral of appropriately selected patients is paramount as further acute decompensation due to infection or altered mental status could preclude them from a comprehensive medical and psycho-social LT evaluation," they add.

SOURCE: https://bit.ly/2N8T6pH

Alcohol Alcoholism 2018.