Hepatology International

, Volume 8, Supplement 2, pp 481–485 | Cite as

Liver transplantation for alcoholic hepatitis. Current situation and future

  • Moana Gelu-SimeonEmail author
  • Jean-Charles Duclos-Vallee
  • Didier Samuel
Supplement Issue: ALPD


Alcoholic hepatitis (AH) is a life-threatening disease, especially in its severe forms, with a 30–40 % mortality rate at 1 month in the absence of treatment. Severe forms are traditionally defined by Maddrey discriminant function >32. Until now, only corticosteroids have provided a significant benefit to survival in severe AH patients. Non-responders to corticosteroid therapy can be identified after 7 days of treatment when the Lille score is above 0.45, and this concerns about 40 % of patients with AH. With so few therapeutic alternatives for severe AH, the debate on liver transplantation (LT) has reopened. However, the latter indication for LT is facing several difficulties such as the 6-month abstinence rule ordinarily required for alcoholic diseases, risk of alcohol relapse and comprehensive fear of a drop in donations. Inversely, transplanted AH patients have a significantly improved survival, and an excess risk of alcohol relapse has not been demonstrated. Solutions can certainly be found in order to improve severe AH survival without causing a loss of opportunity for LT for other indications by good selection according to strict criteria.


Alcoholic hepatitis Alcoholic liver disease Lille score Liver transplantation 


  1. 1.
    European Association for the Study of Liver. EASL clinical practical guidelines: management of alcoholic liver disease. J Hepatol 2012;57:399–420Google Scholar
  2. 2.
    Sandahl TD, Jepsen P, Thomsen KL, Vilstrup H. Incidence and mortality of alcoholic hepatitis in Denmark 1999–2008: a nationwide population based cohort study. J Hepatol 2011;54:760–764PubMedCrossRefGoogle Scholar
  3. 3.
    Naveau S, Giraud V, Borotto E, Aubert A, Capron F, Chaput JC. Excess weight risk factor for alcoholic liver disease. Hepatology 1997;25:108–111PubMedCrossRefGoogle Scholar
  4. 4.
    Katoonizadeh A, Laleman W, Verslype C, Wilmer A, Maleux G, Roskams T, et al. Early features of acute-on-chronic alcoholic liver failure: a prospective cohort study. Gut 2010;59:1561–1569PubMedCrossRefGoogle Scholar
  5. 5.
    Maddrey WC, Boitnott JK, Bedine MS, Weber FL Jr, Mezey E, White RI Jr. Corticosteroid therapy of alcoholic hepatitis. Gastroenterology 1978;75:193–199PubMedGoogle Scholar
  6. 6.
    Carithers RL Jr, Herlong HF, Diehl AM, Shaw EW, Combes B, Fallon HJ, et al. Methylprednisolone therapy in patients with severe alcoholic hepatitis. A randomized multicenter trial. Ann Intern Med 1989;110:685–690.PubMedCrossRefGoogle Scholar
  7. 7.
    Dunn W, Jamil LH, Brown LS, Wiesner RH, Kim WR, Menon KVN, et al. MELD accurately predicts mortality in patients with alcoholic hepatitis. Hepatology 2005;41:353–358PubMedCrossRefGoogle Scholar
  8. 8.
    Dominguez M, Rincón D, Abraldes JG, Miquel R, Colmenero J, Bellot P, et al. A new scoring system for prognostic stratification of patients with alcoholic hepatitis. Am J Gastroenterol 2008;103:2747–2756.PubMedCrossRefGoogle Scholar
  9. 9.
    Monsanto P, Almeida N, Lrias C, Pina JE, Sofia C. Evaluation of MELD Score and Maddrey discriminant function for mortality prediction in patients with alcoholic hepatitis. Hepatogastroenterology 2013;60:1089–1094PubMedGoogle Scholar
  10. 10.
    Sandahl TD, Jepsen P, Ott P, Vilstrup H. Validation of prognostic scores for clinical use in patients with alcoholic hepatitis. Scand J Gastroenterol 2011;46:1127–1132PubMedCrossRefGoogle Scholar
  11. 11.
    Akriviadis E, Botla R, Briggs W, Han S, Reynolds T, Shakil O. Pentoxifylline improves short-term survival in severe acute alcoholic hepatitis: a double-blind, placebo-controlled trial. Gastroenterology 2000;119:1637–1648.PubMedCrossRefGoogle Scholar
  12. 12.
    Louvet A, Naveau S, Abdelnour M, Ramond M-J, Diaz E, Fartoux L, et al. The Lille model: a new tool for therapeutic strategy in patients with severe alcoholic hepatitis treated with steroids. Hepatology 2007;45:1348–1354.PubMedCrossRefGoogle Scholar
  13. 13.
    Mathurin P, O’Grady J, Carithers RL, Phillips M, Louvet A, Mendenhall CL, et al. Corticosteroids improve short-term survival in patients with severe alcoholic hepatitis: meta-analysis of individual patient data. Gut 2011;60:255–260PubMedCrossRefGoogle Scholar
  14. 14.
    Louvet A, Wartel F, Castel H, Dharancy S, Hollebecque A, Canva-Delcambre V, et al. Infection in patients with severe alcoholic hepatitis treated with steroids: early response to therapy is the key factor. Gastroenterology 2009;137:541–548PubMedCrossRefGoogle Scholar
  15. 15.
    Moreno C, Langlet P, Hittelet A, Lasser L, Degré D, Evrard S, et al. Enteral nutrition with or without N-acetylcysteine in the treatment of severe acute alcoholic hepatitis: a randomized multicenter controlled trial. J Hepatol 2010;53:1117–1122PubMedCrossRefGoogle Scholar
  16. 16.
    Phillips M, Curtis H, Portmann B, Donaldson N, Bomford A, O’Grady J. Antioxidants versus corticosteroids in the treatment of severe alcoholic hepatitis: a randomised clinical trial. J Hepatol 2006;44:784–790PubMedCrossRefGoogle Scholar
  17. 17.
    Nguyen-Khac E, Thevenot T, Piquet M-A, Benferhat S, Goria O, Chatelain D, et al. Glucocorticoids plus N-acetylcysteine in severe alcoholic hepatitis. N Engl J Med 2011;365:1781–1789PubMedCrossRefGoogle Scholar
  18. 18.
    Cabré E, Rodríguez-Iglesias P, Caballería J, Quer JC, Sánchez-Lombraña JL, Parés A, et al. Short- and long-term outcome of severe alcohol-induced hepatitis treated with steroids or enteral nutrition: a multicenter randomized trial. Hepatology 2000;32:36–42PubMedCrossRefGoogle Scholar
  19. 19.
    Alvarez MA, Cabré E, Lorenzo-Zúñiga V, Montoliu S, Planas R, Gassull MA. Combining steroids with enteral nutrition: a better therapeutic strategy for severe alcoholic hepatitis? Results of a pilot study. Eur J Gastroenterol Hepatol 2004;16:1375–1380PubMedCrossRefGoogle Scholar
  20. 20.
    Mathurin P, Louvet A, Duhamel A, Nahon P, Carbonell N, Boursier J, et al. Prednisolone with vs without pentoxifylline and survival of patients with severe alcoholic hepatitis: a randomized clinical trial. JAMA 2013;310:1033–1041PubMedCrossRefGoogle Scholar
  21. 21.
    Jalan R, Sen S, Steiner C, Kapoor D, Alisa A, Williams R. Extracorporeal liver support with molecular adsorbents recirculating system in patients with severe acute alcoholic hepatitis. J Hepatol 2003;38:24–31PubMedCrossRefGoogle Scholar
  22. 22.
    Bañares R, Nevens F, Larsen FS, Jalan R, Albillos A, Dollinger M, et al. Extracorporeal albumin dialysis with the molecular adsorbent recirculating system in acute-on-chronic liver failure: the RELIEF trial. Hepatology 2013;57:1153–1162PubMedCrossRefGoogle Scholar
  23. 23.
    Beresford TP, Everson GT. Liver transplantation for alcoholic liver disease: bias, beliefs, 6-month rule, and relapse—but where are the data? Liver Transpl 2000;6:777–778PubMedCrossRefGoogle Scholar
  24. 24.
    Tandon P, Goodman KJ, Ma MM, Wong WW, Mason AL, Meeberg G, et al. A shorter duration of pre-transplant abstinence predicts problem drinking after liver transplantation. Am J Gastroenterol 2009;104:1700–1706PubMedCrossRefGoogle Scholar
  25. 25.
    Stickel F, Hampe J. Genetic determinants of alcoholic liver disease. Gut 2012;61:150–159PubMedCrossRefGoogle Scholar
  26. 26.
    Consensus conference: indications for liver transplantation, January 19 and 20, 2005, Lyon-Palais Des Congrès: text of recommendations (long version). Liver Transpl 2006;12:998–1011Google Scholar
  27. 27.
    Wells JT, Said A, Agni R, Tome S, Hughes S, Dureja P, et al. The impact of acute alcoholic hepatitis in the explanted recipient liver on outcome after liver transplantation. Liver Transpl 2007;13:1728–1735PubMedCrossRefGoogle Scholar
  28. 28.
    Tomé S, Martinez-Rey C, González-Quintela A, Gude F, Brage A, Otero E, et al. Influence of superimposed alcoholic hepatitis on the outcome of liver transplantation for end-stage alcoholic liver disease. J Hepatol 2002;36:793–798PubMedCrossRefGoogle Scholar
  29. 29.
    Singal AK, Bashar H, Anand BS, Jampana SC, Singal V, Kuo Y-F. Outcomes after liver transplantation for alcoholic hepatitis are similar to alcoholic cirrhosis: exploratory analysis from the UNOS database. Hepatology 2012;55:1398–1405PubMedCrossRefGoogle Scholar
  30. 30.
    Mathurin P, Moreno C, Samuel D, Dumortier J, Salleron J, Durand F, et al. Early liver transplantation for severe alcoholic hepatitis. N Engl J Med 2011;365:1790–1800PubMedCrossRefGoogle Scholar
  31. 31.
    Singal AK, Duchini A. Liver transplantation in acute alcoholic hepatitis: current status and future development. World J Hepatol 2011;3:215–218PubMedCrossRefPubMedCentralGoogle Scholar
  32. 32.
    Aguilera V, Berenguer M, Rubín A, San-Juan F, Rayón J-M, Prieto M, et al. Cirrhosis of mixed etiology (hepatitis C virus and alcohol): Posttransplantation outcome-comparison with hepatitis C virus-related cirrhosis and alcoholic-related cirrhosis. Liver Transpl 2009;15:79–87PubMedCrossRefGoogle Scholar
  33. 33.
    Burra P, Senzolo M, Adam R, Delvart V, Karam V, Germani G, et al. Liver transplantation for alcoholic liver disease in Europe: a study from the ELTR (European Liver Transplant Registry). Am J Transpl 2010;10:138–148CrossRefGoogle Scholar
  34. 34.
    Bonet H, Manez R, Kramer D, Wright HI, Gavaler JS, Baddour N, et al. Liver transplantation for alcoholic liver disease: survival of patients transplanted with alcoholic hepatitis plus cirrhosis as compared with those with cirrhosis alone. Alcohol Clin Exp Res 1993;17:1102–1106PubMedCrossRefGoogle Scholar
  35. 35.
    Gustot T, Maillart E, Bocci M, Surin R, Trépo E, Degré D, et al. Invasive aspergillosis in patients with severe alcoholic hepatitis. J Hepatol 2013 [Epub ahead of print].Google Scholar
  36. 36.
    Varma V, Webb K, Mirza DF. Liver transplantation for alcoholic liver disease. World J Gastroenterol 2010;16:4377–4393PubMedCrossRefPubMedCentralGoogle Scholar

Copyright information

© Asian Pacific Association for the Study of the Liver 2013

Authors and Affiliations

  • Moana Gelu-Simeon
    • 1
    • 2
    Email author
  • Jean-Charles Duclos-Vallee
    • 1
    • 2
    • 3
    • 4
  • Didier Samuel
    • 1
    • 2
    • 3
    • 4
  1. 1.Centre Hépato-BiliaireAP-HP Hôpital Paul BrousseVillejuifFrance
  2. 2.DHU HepatinovVillejuifFrance
  3. 3.INSERM, U785VillejuifFrance
  4. 4.Faculté de MédecineUniversité Paris-SudLe Kremlin-BicêtreFrance

Personalised recommendations