■严重急性酒精性肝炎(AAH)的预后极差,短期死亡率很高。因此,许多中心,包括我们自己的,允许移植患者在达到6个月清醒之前被列入移植名单。几个评分系统,旨在针对具有最少清醒时间的患者,已被提议识别患有酒精使用障碍(AUD)的患者,肝移植后容易复发.我们调查了这些评分系统是否证实了我们中心使用的非结构化选择标准的结果,以决定是否进行移植。
■我们进行了一项回顾性病例对照研究,对11例接受AAH早期肝移植的患者进行了回顾性病例对照研究,这些患者与11例因对AUD的低洞察力而被拒绝的对照组相匹配。盲目的评估者证实了DSM-5诊断的严重程度,并在各种用于预测酒精复发的结构化心理测量量表上对患者进行了评分。其中包括酒精复发高风险量表(HRAR),斯坦福大学综合心理社会评估工具(SIPAT),酒精复发风险评估(ARRA)霍普金斯心理社会量表(HPSS),密歇根州酒精中毒预后评分(MAPS),酒精使用障碍识别测试-消费(AUDIT-C)和持续使用酒精后肝移植(盐)量表。对所有接受移植的患者进行有害和无害饮酒的随访,直到研究期结束。
■移植受者的MAPS非常好,赫拉,SIPAT,ARRA,和HPSS得分与他们之前的研究相匹配。SALT和AUDIT-C评分不能预测我们选择的移植患者。尽管快速评估并且没有明显的清醒期,在平均6.6年(5~8.5年)的随访后,我们的病例队列发生有害饮酒的复发率为30%.
■尽管快速评估和短暂的清醒期,患者队列显示30%的有害饮酒复发,与所有形式的酒精性肝病肝移植后报告的饮酒复发率为20%至30%一致。MAPS的平均分数,赫拉,SIPAT,ARRA,HPSS证实了我们目前的分层程序,在移植组中发现较低的平均风险评分。
■AUD和严重AAH患者对其疾病有了新的认识并具有其他有利的社会心理因素,肝移植后AUD复发率较低。在我们机构中,酒精性肝炎患者的社会心理选择标准与5个评分系统中的4个在预测移植后清醒方面一致。
UNASSIGNED: Severe acute alcoholic hepatitis (AAH) has an extremely poor prognosis with a high short term mortality rate. As a result, many centers, including our own, have allowed transplant patients to be listed for transplantation prior to achieving 6-months of sobriety. Several scoring systems, designed to target patients with a minimal period of sobriety, have been proposed to identify patients with alcohol use disorder (AUD), who would be predisposed to relapse after liver transplantation. We investigated whether these scoring systems corroborated the results of the non-structured selection criteria used by our center regarding decision to list for transplant.
UNASSIGNED: We conducted a retrospective case-control study of 11 patients who underwent early liver transplantation for AAH matched with 11 controls who were declined secondary to low insight into AUD. Blinded raters confirmed the severity of the diagnosis of DSM-5 and scored the patients on a variety of structured psychometric scales used to predict alcohol relapse. These included the High Risk for Alcohol Relapse Scale (HRAR), Stanford Integrated Psychosocial Assessment Tool (SIPAT), Alcohol Relapse Risk Assessment (ARRA), Hopkins Psychosocial Scale (HPSS), Michigan Alcoholism Prognosis Score (MAPS), Alcohol Use Disorders Identification Test -Consumption (AUDIT-C), and Sustained Alcohol Use Post-Liver Transplant (SALT) scales. All patients who underwent transplantation were followed for harmful and non-harmful drinking until the end of the study period.
UNASSIGNED: The transplant recipients had significantly favorable MAPS, HRAR, SIPAT, ARRA, and HPSS scores with cutoffs that matched their previous research. The SALT and AUDIT-C scores were not predictive of our selection of patients for transplantation. Despite an expedited evaluation and no significant period of sobriety, our case cohort had a 30% relapse to harmful drinking after an average of 6.6 years (5-8.5 years) of follow-up.
UNASSIGNED: Despite the rapid assessment and the short to no period of sobriety, the patient cohort demonstrated a 30% relapse to harmful drinking, consistent with the 20% to 30% relapse to drinking rate reported after liver transplantation for all forms of alcoholic liver disease. Average scores from MAPS, HRAR, SIPAT, ARRA, and HPSS corroborated our current stratification procedures, with lower mean risk scores found in the transplanted group.
UNASSIGNED: Patients with AUD and severe AAH who obtain new insight into their disease and posses other favorable psychosocial factors have low rates of AUD relapse post-liver-transplantation. The psychosocial selection criteria for patients with alcoholic hepatitis in our institution are consistent with 4 of the 5 scoring systems investigated in their prediction of sobriety post-transplant.