title: Alcoholic hepatitis.
abstract: Alcoholic hepatitis (AH) is a clinical syndrome characterized by jaundice and liver failure that generally occurs after decades of harmful alcohol consumption. Less severe forms of acute AH (AAH) frequently respond to alcoholic abstinence; whereas severe AAHs are characterized by a poor prognosis: up to 40-60% of these patients die within six months. Glucocorticoids currently remain the mainstay for treating severe AAH in patients with Maddrey's Discriminant Function score > 32. Standard contraindications include recent upper gastrointestinal bleeding, renal insufficiency and uncontrolled infections. The evaluation of concomitant viral infections (hepatitis C and B viruses) is mandatory. Liver transplantation (LT), in non-responders patients, is a possible therapeutic option for severe AAH, but it is rarely used because a 6-month abstinence period is required before listing for LT. Unfortunately, most of these patients die before the end of this sober period. In our opinion, in case of severe AAH and in case of patients with a good social support and without severe psychotic or personality disorders, the lack of pre-LT abstinence period alone should not be considered a hindrance to LT.
authors.affiliation: Centro Alcologico Regionale - Regione Liguria, Alcohol Unit, Department of Internal and Specialist Medicine, IRCCS AOU San Martino-National Institute for Cancer research, Genova, Italy. gianni.testino@hsanmartino.it
authors.forename: G
authors.initials: G
authors.lastname: Testino
mesh_terms: D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006519:Hepatitis, Alcoholic / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D008108:Liver Diseases, Alcoholic / Q000188:drug therapy / Q000601:surgery; D016031:Liver Transplantation; D008297:Male
chemical_list: D005938:Glucocorticoids
keywords: Alcoholic Hepatitis; Alcoholic Liver Disease; Liver Transplantation
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