Meeting report: the dallas consensus conference on liver transplantation for alcohol related hepatitis - Université de Lille
Article Dans Une Revue Liver Transplantation Année : 2020

Meeting report: the dallas consensus conference on liver transplantation for alcohol related hepatitis

Sumeet K. Asrani
  • Fonction : Auteur
James Trotter
  • Fonction : Auteur
Jack Lake
  • Fonction : Auteur
Aijaz Ahmed
  • Fonction : Auteur
Anthony Bonagura
  • Fonction : Auteur
Andrew Cameron
  • Fonction : Auteur
Andrea Dimartini
  • Fonction : Auteur
Stevan Gonzalez
  • Fonction : Auteur
Gene Im
  • Fonction : Auteur
Paul Martin
  • Fonction : Auteur
Jessica Mellinger
  • Fonction : Auteur
John P. Rice
  • Fonction : Auteur
Vijay H. Shah
  • Fonction : Auteur
Norah Terrault
  • Fonction : Auteur
Anji Wall
  • Fonction : Auteur
Scott Winder
  • Fonction : Auteur
Goran Klintmalm
  • Fonction : Auteur

Résumé

Liver transplantation (LT) for alcohol associated hepatitis (AH) remains controversial. We convened a consensus conference to examine various aspects of LT for AH. The goal was not to unequivocally endorse LT for AH; instead, it was to propose recommendations for programs that perform or plan to perform LT for AH. Criteria were established to determine candidacy for LT in the setting of AH and included the following: (1) AH patients presenting for the first time with decompensated liver disease that are nonresponders to medical therapy without severe medical or psychiatric comorbidities; (2) a fixed period of abstinence prior to transplantation is not required; and (3) assessment with a multidisciplinary psychosocial team, including a social worker and an addiction specialist/mental health professional with addiction and transplantation expertise. Supporting factors included lack of repeated unsuccessful attempts at addiction rehabilitation, lack of other substance use/dependency, acceptance of diagnosis/insight with a commitment of the patient/family to sobriety, and formalized agreement to adhere to total alcohol abstinence and counseling. LT should be avoided in AH patients who are likely to spontaneously recover. Short-term and longterm survival comparable to other indications for LT must be achieved. There should not be further disparity in LT either by indication, geography, or other sociodemographic factors. Treatment of alcohol-use disorders should be incorporated into pre- and post-LT care. The restrictive and focused evaluation process described in the initial LT experience for AH worldwide may not endure as this indication gains wider acceptance at more LT programs. Transparency in the selection process is crucial and requires the collection of objective data to assess outcomes and minimize center variation in listing. Oversight of program adherence is important to harmonize listing practices and outcomes.

Dates et versions

hal-04525053 , version 1 (28-03-2024)

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Citer

Sumeet K. Asrani, James Trotter, Jack Lake, Aijaz Ahmed, Anthony Bonagura, et al.. Meeting report: the dallas consensus conference on liver transplantation for alcohol related hepatitis. Liver Transplantation, 2020, Liver Transplantation, 26, pp.127-140. ⟨10.1002/lt.25681⟩. ⟨hal-04525053⟩

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