Journal club: Transplantation for severe alcoholic hepatitis

Today’s journal club focused on an article from November, 2011, published in the New England Journal of Medicine.  It dealt with survival outcomes for patients transplanted with severe alcoholic hepatitis.  Although 7 European centers were listed as participatory, only 3 centers did most of the recruiting.

In all, 26 people were transplanted for severe alcoholic hepatitis, defined by DF > 32 at day 1 and Lille Score >0.45 at day 7.  Part of the inclusion data dictated that the alcoholic hepatitis had to be the first episode of liver disease, and there could be no history of decompensated liver disease.  Patients with any psychological comorbidities were excluded.  Therefore, it was a very narrow cohort that was carefully selected.  These case controls were matched to two other groups: those that responded well to steroids (ie. Lille Score <0.45) and those with severe alcoholic hepatitis that did not get transplanted.

As expected, the outcome of transplantation was superior to the severe alc hep group that did not receive transplant, and was similar to those that recovered from their alc hep.  Six of the 26 died following transplant, and a common cause was infection (aspergillus sp.).  Only three experienced EtOH recidivism, which all came more than one year following transplant.

This center was not keen on implementing these excellent outcomes to the current transplant policy.   

 You can view the article by clicking below:

  Transplant for alcoholic hepatitis; NEJM 2011

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