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Acute alcoholic hepatitis, end stage alcoholic liver disease and liver transplantation: An Italian position statement

引用

World Journal of Gastroenterology 2014年第40期20卷 14642-14651页

作者： Gianni Testino Patrizia Burra Ferruccio Bonino Francesco Piani Alessandro Sumberaz Roberto Peressutti Andrea Giannelli Castiglione Valentino Patussi Tiziana Fanucchi Ornella Ancarani Giovanna De Cerce Anna Teresa Iannini Giovanni Greco Antonio Mosti Marilena Durante Paola Babocci Mariano Quartini Davide Mioni sarino aricò Aniello Baselice Silvia Leone Fabiola Lozer Emanuele Scafato Paolo Borro Regional Alcohologic Centre Liguria Region Alcohol Unit and Related Diseases Department of Internal and Specialist Medicine IRCCS AOU San Martino-IST National Institute for Cancer Research 16100 Genova Italy Gastroenterology Department of Surgical and Gastroenterological Sciences University Hospital of Padova Veneto Region 35100 Padova Italy Internal Medicine University of Pisa 56100 Pisa Italy Department of DependenceASS4 Medio Friuli Regione Autonoma Friuli Venezia Giulia34100 Trieste Italy Regional Transplantation Centre Autonomous Region of Friuli Venezia Giulia 33100 Udine Italy Regional Transplantation Centre Liguria Region 16100 Genova Italy Regional AlcohologicCentre Toscana Region Alcohol Unit Careggi Hospital University of Firenze 50100 Firenze Italy Department of Dependence Molise Region 86100 Campobasso Italy Alcohol Unit Department of Dependence Molise Region 86100 Campobasso Italy Alcohol Unit ASL di Ravenna Emilia Romagna Region 48100 Ravenna Italy Alcohol Unit ASL 4 di Terni Umbria Region05100 Terni Italy Hepatology Unit Santa Maria Hospital 05100 Terni Italy Gastroenterology Ordine Mauriziano Hospital Piemonte Region 10100 Torino Italy Italian Clubs of Alcoholics in Treatment 84134 Salerno Italy Department of Toxicology University of Genova 16100 Genova Italy World Health Organization Collaborating Centre for Research and Health Promotion on Alcohol and Alcohol-related Health Problems Europe Region Istituto Superiore di Sanità 00100 Roma Italy

Alcoholic liver disease encompasses a broad spectrum of diseases ranging from steatosis steatohepatitis, fibrosis, and cirrhosis to hepatocellular carcinoma. Forty-four per cent of all deaths from cirrhosis are attributed to alcohol. Alcoholic liver disease is the second most common diagnosis among patients undergoing liver transplantation (LT). The vast majority of transplant programmes (85%) require 6 mo of abstinence prior to transplantation; commonly referred to as the “6-mo rule”. Both in the case of progressive end-stage liver disease (ESLD) and in the case of severe acute alcoholic hepatitis (AAH), not responding to medical therapy, there is a lack of evidence to support a 6-mo sobriety period. It is necessary to identify other risk factors that could be associated with the resumption of alcohol drinking. The “Group of Italian Regions” suggests that: in a case of ESLD with model for end-stage liver disease < 19 a 6-mo abstinence period is required; in a case of ESLD, a 3-mo sober period before LT may be more ideal than a 6-mo period, in selected patients; and in a case of severe AAH, not responding to medical therapies (up to 70% of patients die within 6 mo), LT is mandatory, even without achieving abstinence. The multidisciplinary transplant team must include an addiction specialist/hepato-alcohologist. Patients have to participate in self-help groups.

关键词： Alcohol Alcoholic hepatitis Cirrhosis Hepatocellular carcinoma Liver transplantation

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