Abstract
Alcohol is one of the main causes of liver disease in the Western world. Total alcohol abstinence represents the cornerstone of the management of alcoholic liver disease. When total alcohol abstinence does not result in a significant improvement of liver function, liver transplantation represents the gold standard treatment for alcoholic hepatitis and end-stage alcohol-related cirrhosis. Liver transplantation for patients with alcoholic liver disease still represents matter of debate, principally due to concerns about the risk of post-transplantation recidivism and its effect on the outcome. These issues, coupled with a perception that these patients are likely to have contraindications to transplantation (e.g. extra hepatic alcohol-related disease or lack of self-care) have contributed to a reluctance of many centers to offer liver transplantation to patients affected by alcoholic liver disease. The aim of the present review is to discuss the controversies of liver transplantation for alcoholic liver disease.
Highlights
In particular harmful alcohol use related to Alcohol Use Disorders (AUD) accounts for 3.8% of global mortality and 4.6% of Disability-Adjusted Life Years (DALYs) worldwide [1]
Alcoholic hepatitis is a clinical syndrome characterized by rapid onset of jaundice and liver failure that occurs in patients with chronic alcohol abuse
The analysis showed that patients followed by Alcohol Addiction Unit (AAU) presented lower prevalence of alcohol recidivism and a significantly lower mortality
Summary
In particular harmful alcohol use related to Alcohol Use Disorders (AUD) accounts for 3.8% of global mortality and 4.6% of Disability-Adjusted Life Years (DALYs) worldwide [1]. A total of 9.5% of alcohol-related DALYs is due to Alcoholic Liver Disease (ALD) [2]. It has been reported that nutritional status, gender, ethnicity, iron overload, co-existing metabolic syndrome, chronic viral co-infections ( hepatitis B and C viruses), polymorphisms of genes involved in alcohol metabolism and in the regulation of endotoxin-mediated cytokines release are important additional elements [4]. All these factors can contribute to the progression from the early stage of ALD (fatty liver disease/ steatosis) to steato-hepatitis, fibrosis, cirrhosis and its complications (e.g. hepatocellular carcinoma). The aim of the present review is to discuss the controversies of OLT in ALD
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