Original ResearchFull Report: Clinical—LiverOutcomes of Early Liver Transplantation for Patients With Severe Alcoholic Hepatitis
Graphical abstract
Section snippets
Study Population
Twelve LT centers provided detailed retrospective data on all patients receiving transplants for severe acute AH. Sites were queried about specific selection criteria, the process of selection, and post-transplantation care (Supplementary Table 1). Inclusion criteria were age older than 18 years, presentation with clinically diagnosed severe acute AH (ie, jaundice, prolonged international normalized ratio, chronic and recent alcohol use), no prior diagnosis of chronic liver disease or episodes
Cohort Selection
A total of 147 patients from 12 LT centers across 8 UNOS regions met inclusion and exclusion criteria; 26 of 147 patients were described in prior publications,16, 17 with updated follow-up data included in the current study. Nine of 12 centers, contributing 126 of 147 (86%) patients reliably obtained selection committee data. Of 432 patients with severe AH, 155 (35.9%) were listed and 126 (29.1%) underwent LT (20 died on waitlist, and 9 were delisted due to clinical improvement). The range of
Discussion
The ACCELERATE-AH study includes 12 LT programs in 8 UNOS regions, providing a comprehensive description of the US LT landscape for severe AH. Prior studies were from single centers, thus not necessarily representative of general experience, and lacked sample size to evaluate factors associated with post-LT outcomes. In severe AH, where 6-month mortality can reach 70%, our study shows that early LT is used across the United States as rescue therapy. Indeed, it seems incontrovertible that this
Acknowledgments
Author contributions: Brian Lee: study concept and design, acquisition of data, analysis and interpretation of data, drafting of manuscript, revision of manuscript, statistical analysis. Neil Mehta: study concept and design, analysis and interpretation of data, revision of manuscript. Laura Platt: acquisition of data, analysis and interpretation of data, revision of manuscript. Ahmet Gurakar: acquisition of data, analysis and interpretation of data, revision of manuscript. John Rice:
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Cited by (0)
Conflicts of interest The authors disclose no conflicts.
Funding Supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases: UCSF Liver Center P30 DK026743 and T32 DK060414 to Brian P. Lee.
This article has an accompanying continuing medical education activity, also eligible for MOC credit, on page e21. Learning Objective: Upon completion of this CME activity, successful learners will be able to determine if a patient with severe alcoholic hepatitis is appropriate for consideration of early liver transplantation and identify expected outcomes after transplantation