Rates of recidivism between 11%-49% (defined as any alcohol consumption after transplantation) at 3-5 years after LT have been reported.179, 261 In general, however, only a small fraction of those who undergo liver transplantation for ALD revert to heavy alcohol use or abuse.256 Poor follow-up and noncompliance with therapy are
observed in only a minority of patients, and graft rejection rates are similar for patients PD0332991 molecular weight with ALD compared to those without ALD.255, 260 An important issue that is still unresolved is the role of LT in patients with alcoholic hepatitis, who are generally excluded from transplant.257 In one study using retrospective histological analysis of the explanted liver, superimposed alcoholic hepatitis did not worsen the outcome after LT.262 The availability of living donor transplantation and extended criteria donor liver transplantation are likely
to heighten the debate on this issue. Recommendation: 16. Appropriate patients with end-stage liver disease secondary to alcoholic cirrhosis should be considered for liver transplantation, just as other patients with decompensated liver disease, after careful evaluation of medical and psychosocial candidacy. In addition, this evaluation should include a formal assessment of the likelihood of long-term abstinence RG-7388 price (Class I, Level B). This guideline was produced in collaboration with the Practice Guidelines Committee of the American Association for the Study of Liver Diseases and the Practice Parameters Committee of the American College of Gastroenterology. These committees provided extensive peer review of the manuscript. Members of the AASLD Practice Guidelines Committee include Margaret C. Shuhart, M.D., M.S. (Committee Chair); Gary L. Davis, M.D. (Board Liaison); José Franco, M.D.; Stephen A. Harrison, M.D.; Charles D. Howell, M.D.; Simon C. Ling, MBChB, MRCP; Lawrence U. Liu, M.D.; Paul Martin, M.D.; Nancy Reau, M.D.; Bruce A. Runyon, M.D.; Jayant A. Talwalkar,
上海皓元 M.D., MPH; John B. Wong, M.D.; and Colina Yim, RN, MN. Members of the ACG Practice Parameters Committee include John Inadomi, M.D., FACG (Committee Chair); Darren Baroni, M.D.; David Bernstein, M.D., FACG; William Brugge, M.D., FACG; Lin Chang, M.D.; John Cunningham, M.D., FACG; Kleanthis G. Dendrinos, M.D.; Steven Edmundowicz, M.D.; Philip M. Ginsburg, M.D.; Kelvin Hornbuckle, M.D.; Costas Kefalas, M.D., FACG; Timothy Koch, M.D., FACG; Jenifer Lehrer, M.D.; Anthony Lembo, M.D.; Tarun Mullick, M.D.; John O’Brien, M.D.; John Papp, Sr., M.D., MACG; Henry Parkman, M.D., FACG; Kumaravel S. Perumalsamy, M.D.; Ganapathy A. Prasad, M.D.; Waqar A.Qureshi, M.D., FACG; Albert Roach, Pharm.D., FACG; Richard Sampliner, M.D., MACG; Amnon Sonnenberg, M.D., MSc, FACG; John Vargo, M.D., MPH, FACG; Santhi Swaroop Vege, M.D., FACG; Marcelo Vela, M.D., FACG; Nizar Zein, M.D.; and Marc J. Zuckerman, M.D., FACG.