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Minerva Gastroenterologica e Dietologica 2020 Nov 03

DOI: 10.23736/S1121-421X.20.02778-6


lingua: Inglese

Severe acute alcoholic hepatitis: can we offer early liver transplantation?

Patrizia BURRA 1 , Debora BIZZARO 1, Giovanni FORZA 2, Alessandra FELTRIN 3, Biancarosa VOLPE 3, Andrea RONZAN 4, Giuseppe FELTRIN 5, Giovanni CARRETTA 6, Francesco D'AMICO 7, Umberto CILLO 7, Giacomo GERMANI 1

1 Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padua, Padua, Italy; 2 Department of Legal and Occupational Medicine, Toxicology and Public Health, University Hospital of Padua, Padua, Italy; 3 Psychological Unit, University-Hospital of Padua, Padua, Italy; 4 Psychiatry Unit, University Hospital of Padua, Padua, Italy; 5 Regional Centre for Transplant Coordination, Padua, Italy; 6 Department of Directional Hospital Management, University Hospital of Padua, Padua, Italy; 7 Hepatobiliary Surgery and Liver Transplantation Unit, University Hospital of Padua, Padua, Italy


Alcohol-related liver disease is one of the most prevalent liver disease worldwide and is the second most common indication for liver transplantation. The majority of transplant programs require 6 months of abstinence prior to transplantation; commonly referred to as the “six-month rule”. According to this rule, the patients admitted for severe acute alcoholic hepatitis are not eligible for liver transplantation in most transplant centers. However, there is increasing evidence that if liver transplantation is performed in selected patients after the first episode of severe decompensation with no response to steroid therapy, it represents an effective treatment. In such selected patients, the post-transplant outcomes are good with survival rates that are significantly higher when compared with patients not responding to medical therapy and not transplanted. A multidisciplinary assessment, involving several stakeholders such as a transplant hepatologist, transplant surgeon, psychologist and psychiatrist is becoming mandatory to properly evaluate the candidate to liver transplantation for alcoholic liver diseases and severe acute alcoholic hepatitis. In the clinical setting of severe acute alcoholic hepatitis, further studies are needed for the identification of accepted selection clinical and psychosocial criteria that can provide the best longterm results. The early liver transplantation option should therefore be explored within strict criteria for this setting.

KEY WORDS: Liver transplantation; Severe acute alcoholic hepatitis; Psychosocial assessment

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