title: Liver transplantation for severe alcoholic hepatitis- The PRO view.
abstract: Although liver transplantation has become accepted as a life-saving treatment of last resort for most life-threatening liver disorders, the use of liver transplantation to rescue patients with severe alcoholic hepatitis unresponsive to medical therapy remains controversial. I propose the concepts that alcohol use disorder is an illness, that on occasion results in alcoholic liver disease and that treatment of alcoholic liver disease, including treatment of patients with severe alcoholic hepatitis, combines treatment of the alcohol use disorder and of alcoholic liver disease. From this I derive the following principal to govern selection of patients for liver transplantation of patients with alcohol use disorder: that alcohol use disorder should impact suitability for liver transplantation as a co-morbid disorder, in the same way as other common co-morbid disorders such as diabetes mellitus or systemic hypertension, are factored in the selection process. We should relate the risk of drinking relapse to the prognosis of the patient after transplantation, rather than in a binary construct of likelihood of maintaining abstinence vs drinking.
authors.affiliation: Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors.forename: Michael R
authors.identifier: 0000-0002-0380-7980
authors.initials: MR
authors.lastname: Lucey
mesh_terms: D064829:Alcohol Abstinence; D000428:Alcohol Drinking / Q000009:adverse effects; D006085:Graft Survival; D006519:Hepatitis, Alcoholic / Q000150:complications / Q000601:surgery*; D006801:Humans; D017093:Liver Failure / Q000601:surgery*; D016031:Liver Transplantation / Q000941:ethics*; D018579:Patient Selection; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution
keywords: alcohol use disorder; alcoholic hepatitis; liver; transplantation