Single‐center experience with early liver transplantation for acute alcohol‐related hepatitis—Limitations of the SALT score and directions for future study
Alcohol‐related liver disease (ALD) is the leading indication for liver transplantation worldwide. Since Mathurin et al. described their experience in providing early liver transplantation for patients with ALD in 2011, other centers have followed suit with generally favorable survival outcomes. Thi...
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| Veröffentlicht in: | Clinical transplantation Jg. 38; H. 1; S. e15194 - n/a |
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| Abstract | Alcohol‐related liver disease (ALD) is the leading indication for liver transplantation worldwide. Since Mathurin et al. described their experience in providing early liver transplantation for patients with ALD in 2011, other centers have followed suit with generally favorable survival outcomes. This patient population poses a unique clinical challenge given the expedited nature of the evaluation and the lack of any significant sobriety period prior to transplantation. The SALT (Sustained Alcohol Use Post‐Liver Transplant) score is a standardized psychometric tool increasingly used to help stratify the risk of relapse and guide listing decisions for these challenging clinical situations. In 2018, our center introduced a protocol for early liver transplantation for acute alcohol‐related hepatitis (AAH). In this article, we offer a retrospective review of 26 patients transplanted between May 2018 and May 2021, including at least 1‐year follow‐up, and compare outcomes to initial SALT scores; we further identify additional factors that may impact post‐transplant success. As transplant committees continue to weigh the ethical dilemma of denying lifesaving treatment against the obligation to remain stewards of a limited resource, we aim to contribute to a more nuanced understanding of risk regarding early transplantation for ALD. |
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| AbstractList | Alcohol-related liver disease (ALD) is the leading indication for liver transplantation worldwide. Since Mathurin et al. described their experience in providing early liver transplantation for patients with ALD in 2011, other centers have followed suit with generally favorable survival outcomes. This patient population poses a unique clinical challenge given the expedited nature of the evaluation and the lack of any significant sobriety period prior to transplantation. The SALT (Sustained Alcohol Use Post-Liver Transplant) score is a standardized psychometric tool increasingly used to help stratify the risk of relapse and guide listing decisions for these challenging clinical situations. In 2018, our center introduced a protocol for early liver transplantation for acute alcohol-related hepatitis (AAH). In this article, we offer a retrospective review of 26 patients transplanted between May 2018 and May 2021, including at least 1-year follow-up, and compare outcomes to initial SALT scores; we further identify additional factors that may impact post-transplant success. As transplant committees continue to weigh the ethical dilemma of denying lifesaving treatment against the obligation to remain stewards of a limited resource, we aim to contribute to a more nuanced understanding of risk regarding early transplantation for ALD. Alcohol-related liver disease (ALD) is the leading indication for liver transplantation worldwide. Since Mathurin et al. described their experience in providing early liver transplantation for patients with ALD in 2011, other centers have followed suit with generally favorable survival outcomes. This patient population poses a unique clinical challenge given the expedited nature of the evaluation and the lack of any significant sobriety period prior to transplantation. The SALT (Sustained Alcohol Use Post-Liver Transplant) score is a standardized psychometric tool increasingly used to help stratify the risk of relapse and guide listing decisions for these challenging clinical situations. In 2018, our center introduced a protocol for early liver transplantation for acute alcohol-related hepatitis (AAH). In this article, we offer a retrospective review of 26 patients transplanted between May 2018 and May 2021, including at least 1-year follow-up, and compare outcomes to initial SALT scores; we further identify additional factors that may impact post-transplant success. As transplant committees continue to weigh the ethical dilemma of denying lifesaving treatment against the obligation to remain stewards of a limited resource, we aim to contribute to a more nuanced understanding of risk regarding early transplantation for ALD.Alcohol-related liver disease (ALD) is the leading indication for liver transplantation worldwide. Since Mathurin et al. described their experience in providing early liver transplantation for patients with ALD in 2011, other centers have followed suit with generally favorable survival outcomes. This patient population poses a unique clinical challenge given the expedited nature of the evaluation and the lack of any significant sobriety period prior to transplantation. The SALT (Sustained Alcohol Use Post-Liver Transplant) score is a standardized psychometric tool increasingly used to help stratify the risk of relapse and guide listing decisions for these challenging clinical situations. In 2018, our center introduced a protocol for early liver transplantation for acute alcohol-related hepatitis (AAH). In this article, we offer a retrospective review of 26 patients transplanted between May 2018 and May 2021, including at least 1-year follow-up, and compare outcomes to initial SALT scores; we further identify additional factors that may impact post-transplant success. As transplant committees continue to weigh the ethical dilemma of denying lifesaving treatment against the obligation to remain stewards of a limited resource, we aim to contribute to a more nuanced understanding of risk regarding early transplantation for ALD. |
| Author | Yang, Alexander H. Aaron, Ashley Elizabeth Bethea, Emily D. Ivkovic, Ana Yeh, Heidi Keegan, Eileen Nisavic, Mladen Punko, Diana |
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| References | 2021; 14 2021; 16 2019; 23 2019; 69 2008; 14 2016; 30 2020; 34 2016; 39 2012; 34 2018; 53 2011; 365 2022; 16 2001; 42 2011; 9 e_1_2_9_11_1 e_1_2_9_10_1 e_1_2_9_12_1 e_1_2_9_8_1 e_1_2_9_7_1 e_1_2_9_6_1 e_1_2_9_5_1 e_1_2_9_4_1 e_1_2_9_3_1 e_1_2_9_2_1 Alim TN (e_1_2_9_13_1) 2012; 34 e_1_2_9_9_1 e_1_2_9_15_1 e_1_2_9_14_1 |
| References_xml | – volume: 14 year: 2021 article-title: The contribution of physical exercise to brain resilience publication-title: Front Behav Neurosci – volume: 23 start-page: 1 issue: 7 year: 2019 end-page: 10 article-title: The role of resilience in healthcare transitions among adolescent kidney transplant recipients publication-title: Pediatr Transplant – volume: 16 issue: 6 year: 2021 article-title: Evaluating the association between COVID‐19 and psychiatric presentations, suicidal ideation in an emergency department publication-title: PLoS One – volume: 16 start-page: 138 issue: 2 year: 2022 end-page: 154 article-title: To love and work: a longitudinal study of everyday life factors in recovery from borderline personality disorder publication-title: Personal Ment Health – volume: 34 start-page: 1 issue: 10 year: 2020 end-page: 10 article-title: Evaluating resilience as a predictor of outcomes in lung transplant candidates publication-title: Clin Transplant – volume: 365 start-page: 1790 issue: 19 year: 2011 end-page: 1800 article-title: Early liver transplantation for severe alcoholic hepatitis publication-title: N Engl J Med – volume: 42 start-page: 110 issue: 2 year: 2001 end-page: 116 article-title: Alcoholism treatment after liver transplantation: lessons learned from a clinical trial that failed publication-title: Psychosomatics – volume: 34 start-page: 506 issue: 4 year: 2012 end-page: 515 article-title: Resilience to meet the challenge of addiction: psychobiology and clinical considerations publication-title: Alcohol Res – volume: 53 start-page: 157 issue: 2 year: 2018 end-page: 165 article-title: Post‐transplant outcomes of persons receiving a liver graft for alcoholic liver disease publication-title: Alcohol Alcohol – volume: 30 start-page: 1466 issue: 11 year: 2016 end-page: 1472 article-title: A resilience intervention involving mindfulness training for transplant patients and their caregivers publication-title: Clin Transplant – volume: 69 start-page: 1477 issue: 4 year: 2019 end-page: 1487 article-title: Predicting Low risk for sustained alcohol use after early liver transplant for acute alcoholic hepatitis: the sustained alcohol use post–liver transplant score publication-title: Hepatology – volume: 39 start-page: 86 year: 2016 end-page: 90 article-title: Resilience is associated with low psychological distress in renal transplant recipients publication-title: Gen Hosp Psychiatry – volume: 14 start-page: 159 issue: 2 year: 2008 end-page: 172 article-title: Meta‐analysis of risk for relapse to substance use after transplantation of the liver or other solid organs publication-title: Liver Transplant – volume: 9 start-page: 8 issue: 1 year: 2011 article-title: A methodological review of resilience measurement scales publication-title: Health Qual Life Outcomes – ident: e_1_2_9_14_1 doi: 10.1111/ctr.12841 – ident: e_1_2_9_9_1 doi: 10.3389/fnbeh.2020.626769 – ident: e_1_2_9_15_1 doi: 10.1186/1477‐7525‐9‐8 – ident: e_1_2_9_12_1 doi: 10.1111/petr.13559 – ident: e_1_2_9_11_1 doi: 10.1016/j.genhosppsych.2015.12.004 – ident: e_1_2_9_3_1 doi: 10.1002/hep.30478 – ident: e_1_2_9_4_1 doi: 10.1371/journal.pone.0253805 – volume: 34 start-page: 506 issue: 4 year: 2012 ident: e_1_2_9_13_1 article-title: Resilience to meet the challenge of addiction: psychobiology and clinical considerations publication-title: Alcohol Res – ident: e_1_2_9_2_1 doi: 10.1056/NEJMoa1105703 – ident: e_1_2_9_5_1 doi: 10.1093/alcalc/agx100 – ident: e_1_2_9_7_1 doi: 10.1176/appi.psy.42.2.110 – ident: e_1_2_9_8_1 doi: 10.1002/pmh.1547 – ident: e_1_2_9_10_1 doi: 10.1111/ctr.14056 – ident: e_1_2_9_6_1 doi: 10.1002/lt.21278 |
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| Title | Single‐center experience with early liver transplantation for acute alcohol‐related hepatitis—Limitations of the SALT score and directions for future study |
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