Liver Transplantation

There have been multiple recent studies and reviews concerning liver transplantation in patients with severe alcoholic cirrhosis. There is a well-documented organ shortage for liver transplantation, and there are serious ethical issues concerning this controversial area that have precipitated these studies. HC and ALD are the two major reasons for liver transplantation in the United States. Data clearly demonstrate that patients transplanted for ALD do (short and long term) as well as patients transplanted for HC or other types of liver disease. However, alcoholic hepatitis clearly is not an indication for liver transplantation at the current time. Virtually all centers require that alcoholic patients undergo formal psychiatric examination and treatment before transplantation. Many centers impose a "six month rule" of abstinence before being considered for orthotopic liver transplantation; however, most centers also show some flexibility with this rule. It is unusual for ALD alone to be the cause of graft failure. The majority of patients with ALD are not listed for liver transplantation for multiple reasons including continued alcohol consumption, improvement of liver function with abstinence, lack of interest, etc. Patients with ALD appear to have a higher incidence of certain malignancies of the upper airway and upper digestive tract. Therefore, these patients should be screened for these processes prior to transplantation and monitored carefully posttransplantation.

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