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Establishing a blueprint for successful liver transplantation for alcohol-related cirrhosis:the importance of a multidisciplinary team

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hepatobiliary Surgery and Nutrition 2022年第1期11卷 150-152页

作者： JoséUrsic-Bedoya hélène donnadieu-rigole Department of hepatogastroenterology Hepatology and Liver Transplantation UnitSaint Eloi HospitalUniversity of MontpellierMontpellierFrance Department of Addictology Saint Eloi HospitalUniversity of MontpellierMontpellierFrance

liver transplantation(lT)for alcohol-related liver disease(AlD)has come a long way since the implementation of lT as a standard *** considered a contra-indication due to poor outcomes and moral issues(1,2),it is nowadays the most common indication for lT in Western countries(3,4).Patient and graft survival in this setting are excellent(5).however,relapse rates remain high(6),which jeopardizes long-term survival and the acceptance of the transplant team for these *** evaluation of the suitability to a lT for a potential candidate is therefore *** length of sobriety,namely over six months,has longtime been considered as the condition sine qua ***“6-month rule”is insufficient to predict the risk of relapse and is progressively being abandoned by learned societies recommendations(7,8).Moreover,situations in which a recent alcohol consumption is obvious,such as alcoholic hepatitis or positive blood and/or urine test before the procedure,are associated with good outcomes(9-11).

关键词： alcohol liver urine

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liver transplantation for alcoholic liver disease: lessons learned and unresolved issues

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World Journal of Gastroenterology 2015年第39期21卷 10994-11002页

作者： José Ursic-Bedoya Stéphanie Faure hélène donnadieu-rigole Georges-Philippe Pageaux liver Transplantation Unit Digestive Department Saint Eloi University Hospital University of Montpellier Addictology Department Saint Eloi University Hospital University of Montpellier

The use of liver transplantation(lT) as a treatment for alcoholic liver disease(AlD) has been highly controversial since the beginning. The ever increasing shortage of organs has accentuated the low priority given to patients suffering from AlD, which is considered a "self-inflicted" condition. however, by improving the long-term survival rates, making them similar to those from other indications, and recognizing that alcoholism is a primary disease, AlD has become one of the most common indications for lT in Europe and North America, a situation thought unfathomable thirty years ago. Unfortunately, there are still many issues with the use of this procedure for AlD. There are significant relapse rates, and the consequences of excessive drinking after lT range from asymptomatic biochemical and histological abnormalities to graft failure and death. A minimum three-month period of sobriety is required for an improvement in liver function, thus making lT unnecessary, and to demonstrate the patient's commitment to the project, even though a longer abstinence period does not guarantee lower relapse rates after lT. Recent data have shown that lT is also effective for severe alcoholic hepatitis when the patient is unresponsive to corticosteroids therapy, with low relapse rates in highly selected patients, although these results must be confirmed before lT becomes a standard procedure in this setting. Finally, lT for AlD is accompanied by an increased risk of de novo solid organ cancer, skin cancer, and lymphoproliferative disorders, which has a large impact on the survival rates.

关键词： liver transplantation Alcoholic liver disease Cirr

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Addictive behaviors in liver transplant recipients: The real problem?

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World Journal of hepatology 2017年第22期9卷 953-958页

作者： hélène donnadieu-rigole Pascal Perney José Ursic-Bedoya Stéphanie Faure Georges-Philippe Pageaux Department of Addictology Saint Eloi University Hospital University of Montpellier Department of Addictology Caremeau Hospital liver Transplantation Unit Saint Eloi University Hospital University of Montpellier

liver transplantation(lT) is the gold standard treatment for end-stage liver disease. Whatever the primary indication of lT, substance abuse after surgery may decrease survival rates and quality of life. Prevalence of severe alcohol relapse is between 11 and 26%,and reduces life expectancy regardless of the primary indication of lT. Many patients on waiting lists for lT are smokers and this is a major risk factor for both malignant tumors and cardiovascular events post-surgery. The aim of this review is to describe psychoactive substance consumption after lT, and to assess the impact on liver transplant recipients. This review describes data about alcohol and illicit drug use by transplant recipients and suggests guidelines for behavior management after surgery. The presence of an addiction specialist in a lT team seems to be very important.

关键词： liver transplantation Tobacco use Illicit drugs Behavior management Severe alcohol relapse

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