title: Early Liver Transplantation for Severe Alcoholic Hepatitis in the United States--A Single-Center Experience.
abstract: Early liver transplantation (LT) in European centers reportedly improved survival in patients with severe alcoholic hepatitis (AH) not responding to medical therapy. Our aim was to determine if a strategy of early LT for severe AH could be applied successfully in the United States. We reviewed 111 patients with severe AH at our center from January 2012 to January 2015. The primary end point was mortality at 6 months or early LT, with a secondary end point of alcohol relapse after LT. Survival was compared between those receiving early LT and matched patients who did not. Using a process similar to the European trial, 94 patients with severe AH not responding to medical therapy were evaluated for early LT. Overall, 9 (9.6%) candidates with favorable psychosocial profiles underwent early LT, comprising 3% of all adult LT during the study period. The 6-month survival rate was higher among those receiving early LT compared with matched controls (89% vs 11%, p<0.001). Eight recipients are alive at a median of 735 days with 1 alcohol relapse. Early LT for severe AH can achieve excellent clinical outcomes with low impact on the donor pool and low rates of alcohol relapse in highly selected patients in the United States.
authors.affiliation: Recanati/Miller Transplantation Institute, Division of Liver Diseases, Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: G Y
authors.initials: GY
authors.lastname: Im
authors.affiliation: Recanati/Miller Transplantation Institute, Division of Liver Diseases, Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: L
authors.initials: L
authors.lastname: Kim-Schluger
authors.affiliation: Department of Psychiatry, The Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: A
authors.initials: A
authors.lastname: Shenoy
authors.affiliation: Social Work Services, The Mount Sinai Medical Center, New York, NY.
authors.forename: E
authors.initials: E
authors.lastname: Schubert
authors.affiliation: Division of Liver Diseases, Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: A
authors.initials: A
authors.lastname: Goel
authors.affiliation: Division of Liver Diseases, Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: S L
authors.initials: SL
authors.lastname: Friedman
authors.affiliation: Recanati/Miller Transplantation Institute, Division of Liver Diseases, Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: S
authors.initials: S
authors.lastname: Florman
authors.affiliation: Recanati/Miller Transplantation Institute, Division of Liver Diseases, Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: T D
authors.initials: TD
authors.lastname: Schiano
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006519:Hepatitis, Alcoholic / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors
keywords: Focus: alcoholism and substance abuse; Scope: clinical research/practice; health services and outcomes research Discipline: liver transplantation/hepatology; liver disease