Titre
Liver transplantation for patients with alcoholic hepatitis.
Type
article
Institution
Externe
Périodique
Auteur(s)
Artru, F.
Auteure/Auteur
Louvet, A.
Auteure/Auteur
Mathurin, P.
Auteure/Auteur
Liens vers les personnes
ISSN
1478-3231
Statut éditorial
Publié
Date de publication
2017-03
Volume
37
Numéro
3
Première page
337
Dernière page/numéro d’article
339
Peer-reviewed
Oui
Langue
anglais
Notes
Publication types: Journal Article
Publication Status: ppublish
Publication Status: ppublish
Résumé
Alcoholic liver disease, considered as a self-inflected disease, is an example of how moral judgment may affect ethical exercise of medicine which requires equity and fair utilization of a scarce resource in a context of organ shortage. Some consider that selection process should prioritize access to liver transplantation (LT) for patients who develop liver failure "through no fault of their own" even if limiting care because of a patient's perceived responsibility has been considered unethical. The absence of improvement after alcohol withdrawal, the high short-term mortality risk and the poor predictability of the 6-month rule in post-LT relapse in alcohol consumption in AH patients not responding to medical therapy led to recommend an evaluation of LT. In the French-Belgian pilot study, 26 patients with severe AH not responding to medical therapy underwent early LT (eLT). Stringent selection criteria were applied. Six-month and 2-year survivals of eLT patients were better than that of non-transplanted matched controls: 77% vs 23% and 71% vs 23% respectively. Alcohol relapse occurred in 12% of patients after eLT. Three studies confirmed these results. The impact organ donation should be limited as showed by a recent survey and the efforts that should be made in public information campaigns based on scientific data and medical ethics. In conclusion, the ongoing accumulation of scientific evidence and requirement of ethical exercise of medicine lead to continue evaluating eLT as a therapeutic option in patients with severe AH not responding to medical therapy.
Sujets
PID Serval
serval:BIB_559E2EE50673
PMID
Date de création
2020-10-01T14:07:20.949Z
Date de création dans IRIS
2025-05-20T16:07:39Z