title: Acute alcoholic hepatitis, end stage alcoholic liver disease and liver transplantation: an Italian position statement.
abstract: Alcoholic liver disease encompasses a broad spectrum of diseases ranging from steatosis steatohepatitis, fibrosis, and cirrhosis to hepatocellular carcinoma. Forty-four per cent of all deaths from cirrhosis are attributed to alcohol. Alcoholic liver disease is the second most common diagnosis among patients undergoing liver transplantation (LT). The vast majority of transplant programmes (85%) require 6 mo of abstinence prior to transplantation; commonly referred to as the "6-mo rule". Both in the case of progressive end-stage liver disease (ESLD) and in the case of severe acute alcoholic hepatitis (AAH), not responding to medical therapy, there is a lack of evidence to support a 6-mo sobriety period. It is necessary to identify other risk factors that could be associated with the resumption of alcohol drinking. The "Group of Italian Regions" suggests that: in a case of ESLD with model for end-stage liver disease < 19 a 6-mo abstinence period is required; in a case of ESLD, a 3-mo sober period before LT may be more ideal than a 6-mo period, in selected patients; and in a case of severe AAH, not responding to medical therapies (up to 70% of patients die within 6 mo), LT is mandatory, even without achieving abstinence. The multidisciplinary transplant team must include an addiction specialist/hepato-alcohologist. Patients have to participate in self-help groups.
authors.affiliation: Gianni Testino, Paolo Borro, Alessandro Sumberaz, Ornella Ancarani, Regional Alcohologic Centre, Liguria Region, Alcohol Unit and Related Diseases, Department of Internal and Specialist Medicine, IRCCS AOU San Martino-IST National Institute for Cancer Research, 16100 Genova, Italy.
authors.forename: Gianni
authors.initials: G
authors.lastname: Testino
authors.affiliation: Gianni Testino, Paolo Borro, Alessandro Sumberaz, Ornella Ancarani, Regional Alcohologic Centre, Liguria Region, Alcohol Unit and Related Diseases, Department of Internal and Specialist Medicine, IRCCS AOU San Martino-IST National Institute for Cancer Research, 16100 Genova, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Burra
authors.affiliation: Gianni Testino, Paolo Borro, Alessandro Sumberaz, Ornella Ancarani, Regional Alcohologic Centre, Liguria Region, Alcohol Unit and Related Diseases, Department of Internal and Specialist Medicine, IRCCS AOU San Martino-IST National Institute for Cancer Research, 16100 Genova, Italy.
authors.forename: Ferruccio
authors.initials: F
authors.lastname: Bonino
authors.affiliation: Gianni Testino, Paolo Borro, Alessandro Sumberaz, Ornella Ancarani, Regional Alcohologic Centre, Liguria Region, Alcohol Unit and Related Diseases, Department of Internal and Specialist Medicine, IRCCS AOU San Martino-IST National Institute for Cancer Research, 16100 Genova, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Piani
authors.affiliation: Gianni Testino, Paolo Borro, Alessandro Sumberaz, Ornella Ancarani, Regional Alcohologic Centre, Liguria Region, Alcohol Unit and Related Diseases, Department of Internal and Specialist Medicine, IRCCS AOU San Martino-IST National Institute for Cancer Research, 16100 Genova, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Sumberaz
authors.affiliation: Gianni Testino, Paolo Borro, Alessandro Sumberaz, Ornella Ancarani, Regional Alcohologic Centre, Liguria Region, Alcohol Unit and Related Diseases, Department of Internal and Specialist Medicine, IRCCS AOU San Martino-IST National Institute for Cancer Research, 16100 Genova, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Peressutti
authors.affiliation: Gianni Testino, Paolo Borro, Alessandro Sumberaz, Ornella Ancarani, Regional Alcohologic Centre, Liguria Region, Alcohol Unit and Related Diseases, Department of Internal and Specialist Medicine, IRCCS AOU San Martino-IST National Institute for Cancer Research, 16100 Genova, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Giannelli Castiglione
authors.affiliation: Gianni Testino, Paolo Borro, Alessandro Sumberaz, Ornella Ancarani, Regional Alcohologic Centre, Liguria Region, Alcohol Unit and Related Diseases, Department of Internal and Specialist Medicine, IRCCS AOU San Martino-IST National Institute for Cancer Research, 16100 Genova, Italy.
authors.forename: Valentino
authors.initials: V
authors.lastname: Patussi
authors.affiliation: Gianni Testino, Paolo Borro, Alessandro Sumberaz, Ornella Ancarani, Regional Alcohologic Centre, Liguria Region, Alcohol Unit and Related Diseases, Department of Internal and Specialist Medicine, IRCCS AOU San Martino-IST National Institute for Cancer Research, 16100 Genova, Italy.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Fanucchi
authors.affiliation: Gianni Testino, Paolo Borro, Alessandro Sumberaz, Ornella Ancarani, Regional Alcohologic Centre, Liguria Region, Alcohol Unit and Related Diseases, Department of Internal and Specialist Medicine, IRCCS AOU San Martino-IST National Institute for Cancer Research, 16100 Genova, Italy.
authors.forename: Ornella
authors.initials: O
authors.lastname: Ancarani
authors.affiliation: Gianni Testino, Paolo Borro, Alessandro Sumberaz, Ornella Ancarani, Regional Alcohologic Centre, Liguria Region, Alcohol Unit and Related Diseases, Department of Internal and Specialist Medicine, IRCCS AOU San Martino-IST National Institute for Cancer Research, 16100 Genova, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: De Cerce
authors.affiliation: Gianni Testino, Paolo Borro, Alessandro Sumberaz, Ornella Ancarani, Regional Alcohologic Centre, Liguria Region, Alcohol Unit and Related Diseases, Department of Internal and Specialist Medicine, IRCCS AOU San Martino-IST National Institute for Cancer Research, 16100 Genova, Italy.
authors.forename: Anna Teresa
authors.initials: AT
authors.lastname: Iannini
authors.affiliation: Gianni Testino, Paolo Borro, Alessandro Sumberaz, Ornella Ancarani, Regional Alcohologic Centre, Liguria Region, Alcohol Unit and Related Diseases, Department of Internal and Specialist Medicine, IRCCS AOU San Martino-IST National Institute for Cancer Research, 16100 Genova, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Greco
authors.affiliation: Gianni Testino, Paolo Borro, Alessandro Sumberaz, Ornella Ancarani, Regional Alcohologic Centre, Liguria Region, Alcohol Unit and Related Diseases, Department of Internal and Specialist Medicine, IRCCS AOU San Martino-IST National Institute for Cancer Research, 16100 Genova, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Mosti
authors.affiliation: Gianni Testino, Paolo Borro, Alessandro Sumberaz, Ornella Ancarani, Regional Alcohologic Centre, Liguria Region, Alcohol Unit and Related Diseases, Department of Internal and Specialist Medicine, IRCCS AOU San Martino-IST National Institute for Cancer Research, 16100 Genova, Italy.
authors.forename: Marilena
authors.initials: M
authors.lastname: Durante
authors.affiliation: Gianni Testino, Paolo Borro, Alessandro Sumberaz, Ornella Ancarani, Regional Alcohologic Centre, Liguria Region, Alcohol Unit and Related Diseases, Department of Internal and Specialist Medicine, IRCCS AOU San Martino-IST National Institute for Cancer Research, 16100 Genova, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Babocci
authors.affiliation: Gianni Testino, Paolo Borro, Alessandro Sumberaz, Ornella Ancarani, Regional Alcohologic Centre, Liguria Region, Alcohol Unit and Related Diseases, Department of Internal and Specialist Medicine, IRCCS AOU San Martino-IST National Institute for Cancer Research, 16100 Genova, Italy.
authors.forename: Mariano
authors.initials: M
authors.lastname: Quartini
authors.affiliation: Gianni Testino, Paolo Borro, Alessandro Sumberaz, Ornella Ancarani, Regional Alcohologic Centre, Liguria Region, Alcohol Unit and Related Diseases, Department of Internal and Specialist Medicine, IRCCS AOU San Martino-IST National Institute for Cancer Research, 16100 Genova, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Mioni
authors.affiliation: Gianni Testino, Paolo Borro, Alessandro Sumberaz, Ornella Ancarani, Regional Alcohologic Centre, Liguria Region, Alcohol Unit and Related Diseases, Department of Internal and Specialist Medicine, IRCCS AOU San Martino-IST National Institute for Cancer Research, 16100 Genova, Italy.
authors.forename: Sarino
authors.initials: S
authors.lastname: Aricò
authors.affiliation: Gianni Testino, Paolo Borro, Alessandro Sumberaz, Ornella Ancarani, Regional Alcohologic Centre, Liguria Region, Alcohol Unit and Related Diseases, Department of Internal and Specialist Medicine, IRCCS AOU San Martino-IST National Institute for Cancer Research, 16100 Genova, Italy.
authors.forename: Aniello
authors.initials: A
authors.lastname: Baselice
authors.affiliation: Gianni Testino, Paolo Borro, Alessandro Sumberaz, Ornella Ancarani, Regional Alcohologic Centre, Liguria Region, Alcohol Unit and Related Diseases, Department of Internal and Specialist Medicine, IRCCS AOU San Martino-IST National Institute for Cancer Research, 16100 Genova, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Leone
authors.affiliation: Gianni Testino, Paolo Borro, Alessandro Sumberaz, Ornella Ancarani, Regional Alcohologic Centre, Liguria Region, Alcohol Unit and Related Diseases, Department of Internal and Specialist Medicine, IRCCS AOU San Martino-IST National Institute for Cancer Research, 16100 Genova, Italy.
authors.forename: Fabiola
authors.initials: F
authors.lastname: Lozer
authors.affiliation: Gianni Testino, Paolo Borro, Alessandro Sumberaz, Ornella Ancarani, Regional Alcohologic Centre, Liguria Region, Alcohol Unit and Related Diseases, Department of Internal and Specialist Medicine, IRCCS AOU San Martino-IST National Institute for Cancer Research, 16100 Genova, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Scafato
authors.affiliation: Gianni Testino, Paolo Borro, Alessandro Sumberaz, Ornella Ancarani, Regional Alcohologic Centre, Liguria Region, Alcohol Unit and Related Diseases, Department of Internal and Specialist Medicine, IRCCS AOU San Martino-IST National Institute for Cancer Research, 16100 Genova, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Borro
mesh_terms: D064829:Alcohol Abstinence; D015897:Comorbidity; D006519:Hepatitis, Alcoholic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008104:Liver Cirrhosis, Alcoholic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000592:standards*; D010348:Patient Care Team / Q000592:standards; D018579:Patient Selection; D018570:Risk Assessment; D012307:Risk Factors; D012657:Self-Help Groups / Q000592:standards; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists
keywords: Alcohol; Alcoholic hepatitis; Cirrhosis; Hepatocellular carcinoma; Liver transplantation