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Alcohol use disorder and liver transplant: new perspectives and critical issues

Korean Journal of Internal Medicine 2020년 35권 4호 p.797 ~ 810
 ( Gitto Stefano ) - University of Florence Department of Experimental and Clinical Medicine

 ( Aspite Silvia ) - University of Florence Department of Experimental and Clinical Medicine
 ( Golfieri Lucia ) - University of Bologna Department of Psychology
 ( Caputo Fabio ) - University of Ferrara SS Annunziata Hospital Department of Internal Medicine
 ( Vizzutti Francesco ) - University of Florence Department of Experimental and Clinical Medicine
 ( Grandi Silvana ) - University of Bologna Department of Psychology
 ( Patussi Valentino ) - University Hospital Careggi Alcohology Unit
 ( Marra Fabio ) - University of Florence Department of Experimental and Clinical Medicine

Abstract


Alcoholic liver disease is a consolidated indication for liver transplantation, but many unsolved issues can be highlighted. Patients with alcohol use disorder develop peculiar comorbidities that can become contraindications for transplantation. Moreover, a number of social and psychological patterns should be evaluated to select candidates with a low risk of alcohol relapse and adequate post-transplant adherence. In this context, the 6-month rule is too rigid to be widely applied. A short period of abstinence (1 to 3 months) is useful to estimate recovery of liver function and, possibly to avoid transplant. Cardiovascular disorders and extra-hepatic malignancies represent the main clinical issues after transplant. Patients transplanted due to alcoholic disease are a major risk for other liver diseases. Severe corticosteroid-resistant alcoholic acute hepatitis is a debated indication for transplant. However, available data indicate that well-selected patients have excellent post-transplant outcomes. Behavioral therapy, continued psychological support and a multidisciplinary team are essential to achieve and maintain complete alcohol abstinence during the transplant process. Alcoholic liver disease is an excellent indication for a liver transplant but patients with alcohol use disorder deserve a personalized approach and dedicated resources.

키워드

Liver diseases, alcoholic; Alcoholism; Alcohol and transplant
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