Tags

Type your tag names separated by a space and hit enter

Liver transplantation and alcoholic liver disease: History, controversies, and considerations.
World J Gastroenterol. 2018 Jul 14; 24(26):2785-2805.WJ

Abstract

Alcohol consumption accounts for 3.8% of annual global mortality worldwide, and the majority of these deaths are due to alcoholic liver disease (ALD), mainly alcoholic cirrhosis. ALD is one of the most common indications for liver transplantation (LT). However, it remains a complicated topic on both medical and ethical grounds, as it is seen by many as a "self-inflicted disease". One of the strongest ethical arguments against LT for ALD is the probability of relapse. However, ALD remains a common indication for LT worldwide. For a patient to be placed on an LT waiting list, 6 mo of abstinence must have been achieved for most LT centers. However, this "6-mo rule" is an arbitrary threshold and has never been shown to affect survival, sobriety, or other outcomes. Recent studies have shown similar survival rates among individuals who undergo LT for ALD and those who undergo LT for other chronic causes of end-stage liver disease. There are specific factors that should be addressed when evaluating LT patients with ALD because these patients commonly have a high prevalence of multisystem alcohol-related changes. Risk factors for relapse include the presence of anxiety or depressive disorders, short pre-LT duration of sobriety, and lack of social support. Identification of risk factors and strengthening of the social support system may decrease relapse among these patients. Family counseling for LT candidates is highly encouraged to prevent alcohol consumption relapse. Relapse has been associated with unique histopathological changes, graft damage, graft loss, and even decreased survival in some studies. Research has demonstrated the importance of a multidisciplinary evaluation of LT candidates. Complete abstinence should be attempted to overcome addiction issues and to allow spontaneous liver recovery. Abstinence is the cornerstone of ALD therapy. Psychotherapies, including 12-step facilitation therapy, cognitive-behavioral therapy, and motivational enhancement therapy, help support abstinence. Nutritional therapy helps to reverse muscle wasting, weight loss, vitamin deficiencies, and trace element deficiencies associated with ALD. For muscular recovery, supervised physical activity has been shown to lead to a gain in muscle mass and improvement of functional activity. Early LT for acute alcoholic hepatitis has been the subject of recent clinical studies, with encouraging results in highly selected patients. The survival rates after LT for ALD are comparable to those of patients who underwent LT for other indications. Patients that undergo LT for ALD and survive over 5 years have a higher risk of cardiorespiratory disease, cerebrovascular events, and de novo malignancy.

Authors+Show Affiliations

Guilherme Mariante Neto, Ajacio Bandeira de Mello Brandão, Graduate Program in Medicine: Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90430-080, RS, Brazil.No affiliation info availableGuilherme Mariante Neto, Ajacio Bandeira de Mello Brandão, Graduate Program in Medicine: Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90430-080, RS, Brazil.Guilherme Mariante Neto, Ajacio Bandeira de Mello Brandão, Graduate Program in Medicine: Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90430-080, RS, Brazil.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

30018475

Citation

Marroni, Claudio Augusto, et al. "Liver Transplantation and Alcoholic Liver Disease: History, Controversies, and Considerations." World Journal of Gastroenterology, vol. 24, no. 26, 2018, pp. 2785-2805.
Marroni CA, Fleck AM, Fernandes SA, et al. Liver transplantation and alcoholic liver disease: History, controversies, and considerations. World J Gastroenterol. 2018;24(26):2785-2805.
Marroni, C. A., Fleck, A. M., Fernandes, S. A., Galant, L. H., Mucenic, M., de Mattos Meine, M. H., Mariante-Neto, G., & Brandão, A. B. M. (2018). Liver transplantation and alcoholic liver disease: History, controversies, and considerations. World Journal of Gastroenterology, 24(26), 2785-2805. https://doi.org/10.3748/wjg.v24.i26.2785
Marroni CA, et al. Liver Transplantation and Alcoholic Liver Disease: History, Controversies, and Considerations. World J Gastroenterol. 2018 Jul 14;24(26):2785-2805. PubMed PMID: 30018475.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Liver transplantation and alcoholic liver disease: History, controversies, and considerations. AU - Marroni,Claudio Augusto, AU - Fleck,Alfeu Medeiros,Jr AU - Fernandes,Sabrina Alves, AU - Galant,Lucas Homercher, AU - Mucenic,Marcos, AU - de Mattos Meine,Mario Henrique, AU - Mariante-Neto,Guilherme, AU - Brandão,Ajacio Bandeira de Mello, PY - 2018/04/03/received PY - 2018/05/23/revised PY - 2018/06/16/accepted PY - 2018/7/19/entrez PY - 2018/7/19/pubmed PY - 2018/11/6/medline KW - Alcoholic abstinence KW - Alcoholic cirrhosis KW - Alcoholic hepatitis KW - Alcoholic liver disease KW - Alcoholic recurrence KW - Alcoholism KW - Controversies KW - Liver transplantation KW - Relapse KW - Selection criteria SP - 2785 EP - 2805 JF - World journal of gastroenterology JO - World J Gastroenterol VL - 24 IS - 26 N2 - Alcohol consumption accounts for 3.8% of annual global mortality worldwide, and the majority of these deaths are due to alcoholic liver disease (ALD), mainly alcoholic cirrhosis. ALD is one of the most common indications for liver transplantation (LT). However, it remains a complicated topic on both medical and ethical grounds, as it is seen by many as a "self-inflicted disease". One of the strongest ethical arguments against LT for ALD is the probability of relapse. However, ALD remains a common indication for LT worldwide. For a patient to be placed on an LT waiting list, 6 mo of abstinence must have been achieved for most LT centers. However, this "6-mo rule" is an arbitrary threshold and has never been shown to affect survival, sobriety, or other outcomes. Recent studies have shown similar survival rates among individuals who undergo LT for ALD and those who undergo LT for other chronic causes of end-stage liver disease. There are specific factors that should be addressed when evaluating LT patients with ALD because these patients commonly have a high prevalence of multisystem alcohol-related changes. Risk factors for relapse include the presence of anxiety or depressive disorders, short pre-LT duration of sobriety, and lack of social support. Identification of risk factors and strengthening of the social support system may decrease relapse among these patients. Family counseling for LT candidates is highly encouraged to prevent alcohol consumption relapse. Relapse has been associated with unique histopathological changes, graft damage, graft loss, and even decreased survival in some studies. Research has demonstrated the importance of a multidisciplinary evaluation of LT candidates. Complete abstinence should be attempted to overcome addiction issues and to allow spontaneous liver recovery. Abstinence is the cornerstone of ALD therapy. Psychotherapies, including 12-step facilitation therapy, cognitive-behavioral therapy, and motivational enhancement therapy, help support abstinence. Nutritional therapy helps to reverse muscle wasting, weight loss, vitamin deficiencies, and trace element deficiencies associated with ALD. For muscular recovery, supervised physical activity has been shown to lead to a gain in muscle mass and improvement of functional activity. Early LT for acute alcoholic hepatitis has been the subject of recent clinical studies, with encouraging results in highly selected patients. The survival rates after LT for ALD are comparable to those of patients who underwent LT for other indications. Patients that undergo LT for ALD and survive over 5 years have a higher risk of cardiorespiratory disease, cerebrovascular events, and de novo malignancy. SN - 2219-2840 UR - https://www.unboundmedicine.com/medline/citation/30018475/Liver_transplantation_and_alcoholic_liver_disease:_History_controversies_and_considerations_ L2 - https://www.wjgnet.com/1007-9327/full/v24/i26/2785.htm DB - PRIME DP - Unbound Medicine ER -