S16ALCOHOLIC LIVER DISEASE AND LIVER TRANSPLANTATIONS16.3RELAPSE OF HARMFUL DRINKING IN LIVER-TRANSPLANTED ALCOHOLICS: RISKn STRATIFICATION AND CHALLENGE TO THE 6-MONTH RULES16.4EARLY LIVER TRANSPLANTATION AS A RESCUE OPTION FOR PATIENTS WITH SEVEREn ALCOHOLIC HEPATITIS NON-RESPONSIVE TO THERAPY: A CHANGE OF PARADIGMS?

摘要

Alcoholic liver diesease (ALD) is still the most frequent and lethal complication in chronic alcoholism. Primary treatment modalities are abstinence, agents that suppress inflammation, anticytokine therapy and nutritional support, among others. For alcoholic liver cirrhosis, transplantation is an accepted option but requires careful consideration of alcohol history and future prognosis resp treatment options. Although there is a relationship between the lemgth of sobriety and future abstience, the present methods to predict future drinking are inexact. Approximately 20% of patients return to harmful drinking after transplantation (Lucey, 2011). Compared with other patient groups, relapse rates in patients with ALD are low. A number of other clinical variables apart from length of abstinence (Tandon et al., 2008) may predict outcome as alcohol research shows. This may include alcohol-associated symptoms, previous treatments and psychopathological symptoms including cogntion and history of suicide attempts. In general, DSM-IV-Tr alcoholism criteria appear to have greater utility for predicting survival differences beyond pathophysiologically defined alcoholic liver failure (Rowley et al., 2010). Implications for diagnosis and treatment are discussed.