title: Early liver transplantation for severe alcoholic hepatitis.
abstract: BACKGROUND
  A 6-month abstinence from alcohol is usually required before patients with severe alcoholic hepatitis are considered for liver transplantation. Patients whose hepatitis is not responding to medical therapy have a 6-month survival rate of approximately 30%. Since most alcoholic hepatitis deaths occur within 2 months, early liver transplantation is attractive but controversial.
  
  
  METHODS
  We selected patients from seven centers for early liver transplantation. The patients had no prior episodes of alcoholic hepatitis and had scores of 0.45 or higher according to the Lille model (which calculates scores ranging from 0 to 1, with a score ≥ 0.45 indicating nonresponse to medical therapy and an increased risk of death in the absence of transplantation) or rapid worsening of liver function despite medical therapy. Selected patients also had supportive family members, no severe coexisting conditions, and a commitment to alcohol abstinence. Survival was compared between patients who underwent early liver transplantation and matched patients who did not.
  
  
  RESULTS
  In all, 26 patients with severe alcoholic hepatitis at high risk of death (median Lille score, 0.88) were selected and placed on the list for a liver transplant within a median of 13 days after nonresponse to medical therapy. Fewer than 2% of patients admitted for an episode of severe alcoholic hepatitis were selected. The centers used 2.9% of available grafts for this indication. The cumulative 6-month survival rate (±SE) was higher among patients who received early transplantation than among those who did not (77 ± 8% vs. 23 ± 8%, P<0.001). This benefit of early transplantation was maintained through 2 years of follow-up (hazard ratio, 6.08; P = 0.004). Three patients resumed drinking alcohol: one at 720 days, one at 740 days, and one at 1140 days after transplantation.
  
  
  CONCLUSIONS
  Early liver transplantation can improve survival in patients with a first episode of severe alcoholic hepatitis not responding to medical therapy. (Funded by Société Nationale Française de Gastroentérologie.).
authors: Hôpital Claude Huriez, Services Maladies de l'Appareil Digestif and INSERM Unité 995, Centre Hospitalier Universitaire, de Lille and Université Nord de France, Lille.
authors: Philippe
authors: P
authors: Mathurin
authors: Christophe
authors: C
authors: Moreno
authors: Didier
authors: D
authors: Samuel
authors: Jérôme
authors: J
authors: Dumortier
authors: Julia
authors: J
authors: Salleron
authors: François
authors: F
authors: Durand
authors: Hélène
authors: H
authors: Castel
authors: Alain
authors: A
authors: Duhamel
authors: Georges-Philippe
authors: GP
authors: Pageaux
authors: Vincent
authors: V
authors: Leroy
authors: Sébastien
authors: S
authors: Dharancy
authors: Alexandre
authors: A
authors: Louvet
authors: Emmanuel
authors: E
authors: Boleslawski
authors: Valerio
authors: V
authors: Lucidi
authors: Thierry
authors: T
authors: Gustot
authors: Claire
authors: C
authors: Francoz
authors: Christian
authors: C
authors: Letoublon
authors: Denis
authors: D
authors: Castaing
authors: Jacques
authors: J
authors: Belghiti
authors: Vincent
authors: V
authors: Donckier
authors: François-René
authors: FR
authors: Pruvot
authors: Jean-Charles
authors: JC
authors: Duclos-Vallée
mesh_terms: D000328:Adult; D000437:Alcoholism; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use; D006519:Hepatitis, Alcoholic / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D016016:Proportional Hazards Models; D012008:Recurrence; D015996:Survival Rate; D013695:Temperance; D013997:Time Factors
chemical_list: D005938:Glucocorticoids