Clinical Transplantation, Journal Year: 2024, Volume and Issue: 38(7)
Published: July 1, 2024
Severe alcohol-associated hepatitis (SAH) represents a lethal subset of liver disease. Although corticosteroids are recommended by guidelines, their efficacy and safety remain questionable so transplantation (LT) has been increasingly utilized. The timing indication corticosteroid use, specifically in patients being considered for LT requires further clarification.
Language: Английский
Hepatology International, Journal Year: 2025, Volume and Issue: 19(1), P. 1 - 69
Published: Feb. 1, 2025
Acute-on-chronic liver failure (ACLF) is a condition associated with high mortality in the absence of transplantation. There have been various definitions proposed worldwide. The first consensus report working party Asian Pacific Association for Study Liver (APASL) set 2004 on ACLF was published 2009, and "APASL Research Consortium (AARC)" formed 2012. AARC database has prospectively collected nearly 10,500 cases from countries Asia-Pacific region. This instrumental developing score grade ACLF, concept 'Golden Therapeutic Window', 'transplant window', plasmapheresis as treatment modality. Also, data key to identifying pediatric ACLF. European Liver-Chronic Failure (EASL CLIF) North American End Stage Disease (NACSELD) West added concepts organ infection precipitants development CLIF-Sequential Organ Assessment (SOFA) NACSELD scores prognostication. Chinese Group Severe Hepatitis B (COSSH) COSSH-ACLF criteria manage hepatitis b virus-ACLF without cirrhosis. literature supports these be equally effective their respective cohorts patients mortality. To overcome differences develop global consensus, APASL took initiative invited stakeholders, including opinion leaders Asia, EASL AASLD, other researchers field identify issues an evidence-based document. document presented hybrid format at annual meeting Kyoto March 2024. 'Kyoto Consensus' below carries final recommendations along relevant background information areas requiring future studies.
Language: Английский
Citations
2
Clinics in Liver Disease, Journal Year: 2025, Volume and Issue: unknown
Published: Jan. 1, 2025
Language: Английский
Citations
1
The American Journal of Gastroenterology, Journal Year: 2023, Volume and Issue: 119(5), P. 864 - 874
Published: Nov. 9, 2023
Critically ill patients with cirrhosis admitted to the intensive care unit (ICU) are usually on broad-spectrum antibiotics because of suspected infection or as a hospital protocol. It is unclear if additional rifaximin has any synergistic effect in ICU acute overt hepatic encephalopathy (HE).
Language: Английский
Citations
16
Expert Review of Gastroenterology & Hepatology, Journal Year: 2025, Volume and Issue: unknown
Published: April 23, 2025
In carefully selected individuals, outcomes of early deceased donor liver transplantation (<6 months sobriety) for severe alcohol-associated hepatitis (AAH) are similar to transplant other indications. There is increasing interest in the expansion living (LDLT) AAH. A literature search was conducted PubMed using terms 'alcoholic hepatitis,' 'alcohol-associated 'acute failure' and 'living transplant' between 1995 2025. Additional data sources were International Registry Organ Donation Transplantation, Scientific Transplant Recipients. We summarize global burden disease (ALD), emergence LT Donor- recipient-specific factors explored, as well societal considerations including equitable allocation health system financial impact. Finally, current practices ALD by region reviewed, with a focus on readiness LDLT Use AAH infrequent, but countries experience and/or acute failure most poised expand Progress needed assessing risk return harmful drinking improving management alcohol use disorder.
Language: Английский
Citations
0
Transplantation, Journal Year: 2025, Volume and Issue: unknown
Published: April 24, 2025
Background. Alcohol-associated liver disease (ALD) is the leading indication for transplantation (LT) in Western world. Although 6 mo of abstinence no longer a criterion patients with ALD, outcomes living donor LT (LDLT) versus deceased (DDLT) are not well established. Methodss. We performed an intention-to-treat analysis to evaluate impact listing and pursuing primary LDLT (pLDLT) compared DDLT (pDDLT). The endpoint was overall survival from date listing, evaluated using Cox regression (hazard ratios). Results. Two hundred thirty-three ALD were listed LT, which 27 (12%) pLDLT. median model end-stage (MELD) score at 20 Na-MELD 24, 4.5 mo, 128 (55%) underwent transplantation. There statistically significant adjusted difference 3-y between pLDLT pDDLT (adjusted hazard ratio [HR] 0.72; P = 0.550) as-treated (HR 1.22; 0.741). No delisted group, whereas 86 (42%) group; primarily because death (46 [50%]) medical improvement (24 [28%]). Alcohol use since time documented 29 (13%) patients; immortal bias found HR 1.07; 0.900) 2.95; 0.130). Conclusions. Patients benefit intention lower rates waitlist dropout delisting, attributable mortality or deterioration, should be encouraged pursue this option.
Language: Английский
Citations
0
The Lancet. Gastroenterology & hepatology, Journal Year: 2024, Volume and Issue: 9(11), P. 972 - 974
Published: Sept. 10, 2024
Language: Английский
Citations
3
Zeitschrift für Gastroenterologie, Journal Year: 2025, Volume and Issue: 63(02), P. 133 - 138
Published: Feb. 1, 2025
Abstract Globally, many liver transplantation programs require adherence to a 6-month abstinence period in cases of alcohol-associated disease. Especially decompensation, such as acute-on-chronic failure (ACLF), the severity disease often makes it impossible reach this interval, leading increasing critical scrutiny fixed period. The prognostic relevance is also not firmly established. In present study, we analyze all patients who were presented for at German center due caused by Retrospective analyses with did complete Out 83 initially considered, 78 included final analysis. underwent (n=16) had significantly better 5-year survival rate (81.3% vs. 24.2%; p < 0.001). ACLF and multiple organ dysfunctions (ACLF Grade 3), resulted improved rate. Patients an 3 transplanted died within first six months after decompensation (92.5% mortality). All surviving transplant recipients continued abstaining from alcohol until most recent evaluation point (average follow-up time 963 days). experiencing alcohol-related clearly benefit transplantation, irrespective whether they meet criterion. This stipulated waiting increasingly debated current discussions. Our findings emphasize that ACLF, when transplanted, face significant mortality risks. Such insights should be factored into tailored treatment decisions.
Language: Английский
Citations
0
Liver Transplantation, Journal Year: 2024, Volume and Issue: unknown
Published: July 29, 2024
Hazardous alcohol consumption is the leading cause of liver disease worldwide. Alcohol-associated hepatitis (AH) an acute and serious presentation alcohol-associated that associated with high short-term mortality. Medical management remains limited to corticosteroid therapy intensive nutrition but improves survival in <50% individuals. Liver transplantation (LT) increasingly recognized as a treatment option for many patients AH may lead greater benefits than medical alone. The rate waitlistings LTs has doubled recent years, especially United States. Several studies from West have reported early LT be successful, where deceased donor norm. challenges living centers, particularly those AH, are unique previously not been discussed depth. In this review, we aim discuss LDLT respect candidate selection, ethical considerations, disparities LDLT, post-LT relapse, measures prevent them while also addressing definitions outcomes early-living AH.
Language: Английский
Citations
2
Alimentary Pharmacology & Therapeutics, Journal Year: 2024, Volume and Issue: 59(9), P. 1049 - 1061
Published: March 12, 2024
Summary Background Alcohol‐associated hepatitis (AH) is a severe inflammatory form of alcohol‐associated liver disease (ALD) that carries high mortality rate. Early transplantation for AH increasingly available. However, specific criteria referral and selection remain subject debate. Aims To provide narrative review the natural history, diagnostic indications early AH. Methods We searched PubMed articles published through August 2023. Key search terms were ‘alcoholic hepatitis,’ ‘alcohol‐associated ‘abstinence,’ ‘alcohol relapse,’ ‘liver transplantation.’ Results Previously, six‐month period alcohol abstinence was required before patients with ALD considered transplantation. studies in recent years have demonstrated that, among carefully selected patients, who received transplants much higher survival rates than similarly did not undergo (77% vs. 23%). Despite these successes, remains controversial, as typically undergone treatment use disorder, ensuing risk returning to use. Conclusions While has benefits, many would disorder. An integrated approach evaluating candidacy needed.
Language: Английский
Citations
1
Indian Journal of Gastroenterology, Journal Year: 2024, Volume and Issue: unknown
Published: June 7, 2024
Language: Английский
Citations
1