Liver transplant for alcoholic hepatitis: a current clinical overview

ABSTRACT

Introduction

Current management of severe alcoholic hepatitis is based on corticosteroid therapy and abstinence from alcohol. As liver transplantation is lifesaving in alcoholic hepatitis patients at high risk of early death, refractory alcoholic hepatitis has become a new indication for liver transplantation in highly selected non-responders to corticosteroids.

Areas covered

This review summarizes the conditions under which liver transplantation may be considered, the available data on liver transplantation for refractory alcoholic hepatitis and explores the ethical considerations surrounding the use of liver transplantation in these patients.

Expert opinion

Selection of candidates should be made according to available scientific results on post-liver transplantation outcomes and the risk of alcohol relapse. Currently, a strict selection process based on a good psychosocial profile, including social stability, no previous treatments for alcohol dependence, no current drug use, and no co-existing severe mental disorder, seems to be the best way to manage these issues. Well-defined selection criteria for candidate selection and accurate tools to predict alcohol relapse after liver transplantation are still needed.

KEYWORDS:

• Abstinence
• alcoholic hepatitis
• alcohol relapse
• liver transplantation
• prognosis

Article highlights

• Current management of severe AH is based on corticosteroid therapy and abstinence from alcohol.

• A number of studies have provided evidence that liver transplantation is lifesaving in AH patients at high risk of early death.

• Refractory AH has become a new indication for liver transplantation in highly selected non-responders to corticosteroids.

• Equity should be respected in the setting of AH as in other conditions in which liver transplantation is discussed.

• Selection of candidates should be made according to available scientific results on post-liver transplantation outcomes and the risk of alcohol relapse. Currently, a strict selection process, similar to the one used in the French-Belgian landmark study, seems to be the best way to manage these issues.

• Well-defined selection criteria for candidate selection and accurate tools to predict alcohol relapse after liver transplantation are still needed. These will contribute to ensuring the perpetuation of the liver transplantation program for highly-selected patients with refractory AH from the perspective of both healthcare providers and the public.

Acknowledgments

We acknowledge the contribution of Sandy Field, PhD, for her assistance concerning English-language editing

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.