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Early liver transplantation for severe alcoholic hepatitis

moving from controversy to consensus

Lee, Brian P.; Terrault, Norah A.

Current Opinion in Organ Transplantation: April 2018 - Volume 23 - Issue 2 - p 229–236
doi: 10.1097/MOT.0000000000000507

Purpose of review Alcohol-related liver disease is now the most common indication for liver transplant in the United States. Acute alcoholic hepatitis represents a subpopulation with short-term mortality approaching 70% in severe cases – these patients are not typically eligible for liver transplant, as most centers require a period of alcohol abstinence (typically 6 months) prior to transplant. Early liver transplant (prior to a requisite period of abstinence) is being increasingly offered in a minority of U.S. centers. The present review examines clinical and ethical considerations surrounding liver transplant for severe alcoholic hepatitis, key published studies and knowledge gaps, and future directions for clinical research to achieve optimal patient outcomes.

Recent findings Since a European pilot study published in 2011, published U.S. original studies in early liver transplantation for severe alcoholic hepatitis are limited to 1 UNOS review, and 2 retrospective single-center studies. A preliminary report from the ACCELERATE-AH consortium show short-term outcomes are acceptable and that use of alcohol posttransplant occurs in 25% of patients. These studies confirm the survival benefit of early liver transplant for alcoholic hepatitis and report rates of alcohol use posttransplant similar to historic cohorts in alcohol-related cirrhosis.

Summary Early liver transplantation for severe alcoholic hepatitis is lifesaving, with acceptable short to intermediate-term patient survival and rates of alcohol use posttransplant. Further study is needed to determine long-term outcomes, and how best to select and manage patients for this new indication for liver transplant.

Divison of Gastroenterology/Hepatology, University of California San Francisco, San Francisco, California, USA

Correspondence to Norah A. Terrault, MD, 513 Parnassus Avenue, Room S-357, San Francisco, CA 94143, USA. Tel: +415 502 0318; fax: +415 476 0659; e-mail:

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