Living Donor Liver Transplantation for Severe Alcoholic Hepatitis Not Responding to Medical Management: An Experience of 31 Patients

Abstract

Background and Aim: There is limited data on outcomes of living donor liver transplantation (LDLT) for alcoholic hepatitis. Methods: The study included LDLT recipients for severe alcoholic hepatitis not responding to medical management (n = 31), diagnosis of alcoholic hepatitis was both clinical and explant based. Immunosuppression protocol consisted of calcineurin inhibitors (mainly tacrolimus), mycophenolate and short-term steroids. The data is shown number, mean (SD) or median (25–75 IQR). Results: All LDLT recipients were males. The disease severity score before LDLT were as follows; Child's 11.1 ± 1, MELD 23.7 ± 4.1, modified Maddrey's discriminant function (mDF) score 54 (33–81). These patients were abstinent for a duration of 3 (2–6) months before LDLT and none had psychiatric contraindication for transplant. The serum biochemistries were as follows; bilirubin 8.7 (6–15) mg/dl, INR 2 ± 0.4, albumin 2.8 ± 0.4 g/dl. All patients underwent LDLT with a Graft to recipient weight ratio (GRWR) of 0.95 ± 0.17. The post-transplant ICU and hospital stay were 5 ± 1 and 16 ± 7 days. A total of seven (22.5%) patients had fungal infections. Biliary complications occurred in 5 patients. A total of five patients (16%) died during a follow up of 19 (11–26) months; causes of death included bacterial sepsis in 4 and colonic mucormycosis in one, the survival curve is shown in Figure 1. Four patients had relapse of alcohol intake (one occasional, two moderate and one heavy amount of alcohol intake). Conclusion: Living donor liver transplantation for severe alcoholic hepatitis not responding to medical management is associated with good survival. The authors have none to declare.