Survey of Liver Transplantation Practices for Severe Acute Alcoholic Hepatitis

Saroja Bangaru, Mark R. Pedersen, Malcolm P MacConmara, Amit Singal, Arjmand R Mufti

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Liver transplantation (LT) has a demonstrated survival benefit in select patients with severe acute alcoholic hepatitis (SAH) who do not respond to steroids, but prior studies suggest low adoption among US LT centers. Our study explored current perceptions and practice patterns of LT for SAH in the United States. We administered a Web-based survey to medical directors of US LT centers between May and October of 2017 to characterize practice patterns and perceptions of LT for SAH. We obtained responses from 45 (41.3%) of 109 surveyed centers, representing all 11 (100%) United Network for Organ Sharing regions. Half (n = 23; 51.1%) reported performing at least 1 LT for SAH, although most (n = 19; 82.6%) of those had performed ≤5 LTs for that indication. Centers expressed near consensus for selection criteria, requiring strong social support (100%), no prior presentations with SAH (91.3%), absence of a severe coexisting psychiatric disorder (91.3%), and official psychosocial evaluation (87.0%). Reported posttransplant survival of SAH patients was excellent, with 17 (73.9%) centers reporting 1-year posttransplant survival exceeding 90%. Among centers that had not performed LT for SAH, the most commonly cited reason was perceived high risk of alcohol relapse. In conclusion, our data demonstrate that LT is increasingly adopted as a therapeutic intervention for patients with SAH and that careful selection allows for excellent 1-year posttransplant survival. Despite this, nearly half of US centers do not perform LT for this indication due to perceived high risk of alcohol relapse. Our data support the use of LT for well-selected patients with SAH.

Original languageEnglish (US)
Pages (from-to)1357-1362
Number of pages6
JournalLiver Transplantation
Volume24
Issue number10
DOIs
StatePublished - Oct 1 2018

Fingerprint

Alcoholic Hepatitis
Liver Transplantation
Survival
Alcohols
Surveys and Questionnaires
Physician Executives
Recurrence
Social Support
Patient Selection
Psychiatry
Steroids

ASJC Scopus subject areas

  • Surgery
  • Hepatology
  • Transplantation

Cite this

Survey of Liver Transplantation Practices for Severe Acute Alcoholic Hepatitis. / Bangaru, Saroja; Pedersen, Mark R.; MacConmara, Malcolm P; Singal, Amit; Mufti, Arjmand R.

In: Liver Transplantation, Vol. 24, No. 10, 01.10.2018, p. 1357-1362.

Research output: Contribution to journalArticle

@article{60de6defc52243aca120ab83d51eb00e,
title = "Survey of Liver Transplantation Practices for Severe Acute Alcoholic Hepatitis",
abstract = "Liver transplantation (LT) has a demonstrated survival benefit in select patients with severe acute alcoholic hepatitis (SAH) who do not respond to steroids, but prior studies suggest low adoption among US LT centers. Our study explored current perceptions and practice patterns of LT for SAH in the United States. We administered a Web-based survey to medical directors of US LT centers between May and October of 2017 to characterize practice patterns and perceptions of LT for SAH. We obtained responses from 45 (41.3{\%}) of 109 surveyed centers, representing all 11 (100{\%}) United Network for Organ Sharing regions. Half (n = 23; 51.1{\%}) reported performing at least 1 LT for SAH, although most (n = 19; 82.6{\%}) of those had performed ≤5 LTs for that indication. Centers expressed near consensus for selection criteria, requiring strong social support (100{\%}), no prior presentations with SAH (91.3{\%}), absence of a severe coexisting psychiatric disorder (91.3{\%}), and official psychosocial evaluation (87.0{\%}). Reported posttransplant survival of SAH patients was excellent, with 17 (73.9{\%}) centers reporting 1-year posttransplant survival exceeding 90{\%}. Among centers that had not performed LT for SAH, the most commonly cited reason was perceived high risk of alcohol relapse. In conclusion, our data demonstrate that LT is increasingly adopted as a therapeutic intervention for patients with SAH and that careful selection allows for excellent 1-year posttransplant survival. Despite this, nearly half of US centers do not perform LT for this indication due to perceived high risk of alcohol relapse. Our data support the use of LT for well-selected patients with SAH.",
author = "Saroja Bangaru and Pedersen, {Mark R.} and MacConmara, {Malcolm P} and Amit Singal and Mufti, {Arjmand R}",
year = "2018",
month = "10",
day = "1",
doi = "10.1002/lt.25285",
language = "English (US)",
volume = "24",
pages = "1357--1362",
journal = "Liver Transplantation",
issn = "1527-6465",
publisher = "John Wiley and Sons Ltd",
number = "10",

}

TY - JOUR

T1 - Survey of Liver Transplantation Practices for Severe Acute Alcoholic Hepatitis

AU - Bangaru, Saroja

AU - Pedersen, Mark R.

AU - MacConmara, Malcolm P

AU - Singal, Amit

AU - Mufti, Arjmand R

PY - 2018/10/1

Y1 - 2018/10/1

N2 - Liver transplantation (LT) has a demonstrated survival benefit in select patients with severe acute alcoholic hepatitis (SAH) who do not respond to steroids, but prior studies suggest low adoption among US LT centers. Our study explored current perceptions and practice patterns of LT for SAH in the United States. We administered a Web-based survey to medical directors of US LT centers between May and October of 2017 to characterize practice patterns and perceptions of LT for SAH. We obtained responses from 45 (41.3%) of 109 surveyed centers, representing all 11 (100%) United Network for Organ Sharing regions. Half (n = 23; 51.1%) reported performing at least 1 LT for SAH, although most (n = 19; 82.6%) of those had performed ≤5 LTs for that indication. Centers expressed near consensus for selection criteria, requiring strong social support (100%), no prior presentations with SAH (91.3%), absence of a severe coexisting psychiatric disorder (91.3%), and official psychosocial evaluation (87.0%). Reported posttransplant survival of SAH patients was excellent, with 17 (73.9%) centers reporting 1-year posttransplant survival exceeding 90%. Among centers that had not performed LT for SAH, the most commonly cited reason was perceived high risk of alcohol relapse. In conclusion, our data demonstrate that LT is increasingly adopted as a therapeutic intervention for patients with SAH and that careful selection allows for excellent 1-year posttransplant survival. Despite this, nearly half of US centers do not perform LT for this indication due to perceived high risk of alcohol relapse. Our data support the use of LT for well-selected patients with SAH.

AB - Liver transplantation (LT) has a demonstrated survival benefit in select patients with severe acute alcoholic hepatitis (SAH) who do not respond to steroids, but prior studies suggest low adoption among US LT centers. Our study explored current perceptions and practice patterns of LT for SAH in the United States. We administered a Web-based survey to medical directors of US LT centers between May and October of 2017 to characterize practice patterns and perceptions of LT for SAH. We obtained responses from 45 (41.3%) of 109 surveyed centers, representing all 11 (100%) United Network for Organ Sharing regions. Half (n = 23; 51.1%) reported performing at least 1 LT for SAH, although most (n = 19; 82.6%) of those had performed ≤5 LTs for that indication. Centers expressed near consensus for selection criteria, requiring strong social support (100%), no prior presentations with SAH (91.3%), absence of a severe coexisting psychiatric disorder (91.3%), and official psychosocial evaluation (87.0%). Reported posttransplant survival of SAH patients was excellent, with 17 (73.9%) centers reporting 1-year posttransplant survival exceeding 90%. Among centers that had not performed LT for SAH, the most commonly cited reason was perceived high risk of alcohol relapse. In conclusion, our data demonstrate that LT is increasingly adopted as a therapeutic intervention for patients with SAH and that careful selection allows for excellent 1-year posttransplant survival. Despite this, nearly half of US centers do not perform LT for this indication due to perceived high risk of alcohol relapse. Our data support the use of LT for well-selected patients with SAH.

UR - http://www.scopus.com/inward/record.url?scp=85055440890&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85055440890&partnerID=8YFLogxK

U2 - 10.1002/lt.25285

DO - 10.1002/lt.25285

M3 - Article

C2 - 30141270

AN - SCOPUS:85055440890

VL - 24

SP - 1357

EP - 1362

JO - Liver Transplantation

JF - Liver Transplantation

SN - 1527-6465

IS - 10

ER -