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World J Gastroenterol. Oct 28, 2014; 20(40): 14642-14651
Published online Oct 28, 2014. doi: 10.3748/wjg.v20.i40.14642
Acute alcoholic hepatitis, end stage alcoholic liver disease and liver transplantation: An Italian position statement
Gianni Testino, Patrizia Burra, Ferruccio Bonino, Francesco Piani, Alessandro Sumberaz, Roberto Peressutti, Andrea Giannelli Castiglione, Valentino Patussi, Tiziana Fanucchi, Ornella Ancarani, Giovanna De Cerce, Anna Teresa Iannini, Giovanni Greco, Antonio Mosti, Marilena Durante, Paola Babocci, Mariano Quartini, Davide Mioni, Sarino Aricò, Aniello Baselice, Silvia Leone, Fabiola Lozer, Emanuele Scafato, Paolo Borro
Gianni Testino, Paolo Borro, Alessandro Sumberaz, Ornella Ancarani, Regional Alcohologic Centre, Liguria Region, Alcohol Unit and Related Diseases, Department of Internal and Specialist Medicine, IRCCS AOU San Martino-IST National Institute for Cancer Research, 16100 Genova, Italy
Patrizia Burra, Davide Mioni, Gastroenterology, Department of Surgical and Gastroenterological Sciences, University Hospital of Padova, Veneto Region, 35100 Padova, Italy
Ferruccio Bonino, Internal Medicine, University of Pisa, 56100 Pisa, Italy
Francesco Piani, Fabiola Lozer, Department of Dependence ASS4 Medio Friuli, Regione Autonoma Friuli Venezia Giulia, 34100 Trieste, Italy
Roberto Peressutti, Regional Transplantation Centre, Autonomous Region of Friuli Venezia Giulia, 33100 Udine, Italy
Andrea Giannelli Castiglione, Regional Transplantation Centre, Liguria Region, 16100 Genova, Italy
Valentino Patussi, Tiziana Fanucchi, Regional Alcohologic Centre, Toscana Region, Alcohol Unit, Careggi Hospital, University of Firenze, 50100 Firenze, Italy
Giovanna De Cerce, Department of Dependence, Molise Region, 86100 Campobasso, Italy
Anna Teresa Iannini, Alcohol Unit, Department of Dependence, Molise Region, 86100 Campobasso, Italy
Giovanni Greco, Antonio Mosti, Marilena Durante, Alcohol Unit, ASL di Ravenna, Emilia Romagna Region, 48100 Ravenna, Italy
Paola Babocci, Alcohol Unit, ASL 4 di Terni, Umbria Region, 05100 Terni, Italy
Mariano Quartini, Hepatology Unit, Santa Maria Hospital, 05100 Terni, Italy
Sarino Aricò, Gastroenterology, Ordine Mauriziano Hospital, Piemonte Region, 10100 Torino, Italy
Aniello Baselice, Italian Clubs of Alcoholics in Treatment, 84134 Salerno, Italy
Silvia Leone, Department of Toxicology, University of Genova, 16100 Genova, Italy
Emanuele Scafato, World Health Organization Collaborating Centre for Research and Health Promotion on Alcohol and Alcohol-related Health Problems, Europe Region, Istituto Superiore di Sanità, 00100 Roma, Italy
Author contributions: Testino G wrote the article; Leone S made ​​the corrections to the text in English; Borro P edited the manuscript; all authors participated in the drafting of the document.
Correspondence to: Dr. Gianni Testino, Regional Alcohologic Centre, Liguria Region, Alcohol Unit and Related Diseases, Department of Internal and Specialist Medicine, IRCCS AOU San Martino-IST National Institute for Cancer Research, Piazzale R. Benzi 10, 16132 Genova, Italy. gianni.testino@hsanmartino.it
Telephone: +39-10-5552769 Fax: +39-10-5556738
Received: October 28, 2013
Revised: January 18, 2014
Accepted: June 20, 2014
Published online: October 28, 2014
Processing time: 366 Days and 14.5 Hours
Abstract

Alcoholic liver disease encompasses a broad spectrum of diseases ranging from steatosis steatohepatitis, fibrosis, and cirrhosis to hepatocellular carcinoma. Forty-four per cent of all deaths from cirrhosis are attributed to alcohol. Alcoholic liver disease is the second most common diagnosis among patients undergoing liver transplantation (LT). The vast majority of transplant programmes (85%) require 6 mo of abstinence prior to transplantation; commonly referred to as the “6-mo rule”. Both in the case of progressive end-stage liver disease (ESLD) and in the case of severe acute alcoholic hepatitis (AAH), not responding to medical therapy, there is a lack of evidence to support a 6-mo sobriety period. It is necessary to identify other risk factors that could be associated with the resumption of alcohol drinking. The “Group of Italian Regions” suggests that: in a case of ESLD with model for end-stage liver disease < 19 a 6-mo abstinence period is required; in a case of ESLD, a 3-mo sober period before LT may be more ideal than a 6-mo period, in selected patients; and in a case of severe AAH, not responding to medical therapies (up to 70% of patients die within 6 mo), LT is mandatory, even without achieving abstinence. The multidisciplinary transplant team must include an addiction specialist/hepato-alcohologist. Patients have to participate in self-help groups.

Keywords: Alcohol; Alcoholic hepatitis; Cirrhosis; Hepatocellular carcinoma; Liver transplantation

Core tip: Alcoholic liver disease is the second most common diagnosis among patients undergoing liver transplantation. The vast majority of transplant programmes (85%) require 6 mo of abstinence prior to transplantation; commonly referred to as the “6-mo rule”. The “Group of Italian Regions” suggests a reduction of the waiting period in some cases. The multidisciplinary transplant team must include an addiction specialist/hepato-alcohologist. Patients have to participate in self-help groups.