Journal article
Expedited liver transplantation as first-line therapy for severe alcohol hepatitis: ELFSAH; deferring corticosteroids in the sickest subset of patients
Clinical transplantation, v 38(7), pp e15340-n/a
Jul 2024
PMID: 39049597
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Severe alcohol-associated hepatitis (SAH) represents a lethal subset of alcohol-associated liver disease. Although corticosteroids are recommended by guidelines, their efficacy and safety remain questionable and so liver transplantation (LT) has been increasingly utilized. The timing and indication of corticosteroid use, specifically in patients being considered for LT requires further clarification.
A retrospective analysis was conducted on 256 patients with SAH between 2018 and 2022 at a single US center.
Twenty of these patients underwent LT. Of the 256 patients, 38% had what we termed "catastrophic" SAH, defined as a MELD-Na ≥35 and/or discriminant function (DF) ≥100, which carried a mortality of 90% without LT. Compared with 100 matched controls, patients undergoing LT exhibited a one-year survival rate of 100% versus 35% (p < .0005). LT provided an absolute risk reduction of 65%, with a number needed to treat of 1.5. Steroid utilization in the entire cohort was 19% with 60% developing severe complications. Patients administered steroids were younger with lower MELD and DF scores. Only 10% of those prescribed steroids derived a favorable response. Sustained alcohol use post-LT was 20%.
We propose ELFSAH: Expedited LT as First Line Therapy for SAH; challenging the current paradigm with recommendations to defer steroids in patients with "catastrophic" SAH (defined as: MELD-Na ≥35 and/or DF ≥100). Patients should be seen urgently by hepatology, transplant surgery, psychiatry and social work. Patients without an absolute contraindication should be referred for LT as first-line therapy during their index admission.
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Details
- Title
- Expedited liver transplantation as first-line therapy for severe alcohol hepatitis: ELFSAH; deferring corticosteroids in the sickest subset of patients
- Creators
- Nabeeha Mohy-Ud-Din - University of Pittsburgh Medical CenterFei-Pi Lin - University of Pittsburgh Medical CenterVikrant Rachakonda - VA Northern California Health Care SystemAli Al-Khafaji - University of Pittsburgh Medical CenterScott W Biggins - University of Pittsburgh Medical CenterSwaytha Ganesh - University of Pittsburgh Medical CenterRamon Bataller - Hospital Clínic de BarcelonaAndrea DiMartini - University of PittsburghChristopher Hughes - University of Pittsburgh Medical CenterAbhinav Humar - University of Pittsburgh Medical CenterShahid M Malik - University of Pittsburgh Medical Center
- Publication Details
- Clinical transplantation, v 38(7), pp e15340-n/a
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- General Internal Medicine
- Web of Science ID
- WOS:001275970700001
- Scopus ID
- 2-s2.0-85199488532
- Other Identifier
- 991022076808104721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Surgery
- Transplantation