Background A 6-month abstinence from alcohol is usually required before patients with severe alcoholic hepatitis are considered for liver transplantation. Patients whose hepatitis is not responding to medical therapy have a 6-month survival rate of approximately 30%. Since most alcoholic hepatitis deaths occur within 2 months, early liver transplantation is attractive but controversial. Methods We selected patients from seven centers for early liver transplantation. The patients had no prior episodes of alcoholic hepatitis and had scores of 0.45 or higher according to the Lille model (which calculates scores ranging from 0 to 1, with a score ≥0.45 indicating nonresponse to medical therapy and an increased risk of death in the absence of transplantation) or rapid worsening of liver function despite medical therapy. Selected patients also had supportive family members, no severe coexisting conditions, and a commitment to alcohol abstinence. Survival was compared between patients who underwent early liver tr...

https://www.nejm.org/doi/pdf/10.1056/NEJMoa1105703

Early Liver Transplantation for Severe Alcoholic Hepatitis

https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1002/lt.20934

Long-term survival and predictors of relapse after orthotopic liver transplantation for alcoholic liver disease.

Screening for hepatocellular carcinoma in patients with hepatitis C cirrhosis: A cost-utility analysis

https://sites.ualberta.ca/~loewen/Medicine/GIM%20Residents%20Core%20Reading/LIVER%20MASSES/screeningHCC.pdf

Screening for hepatocellular carcinoma in cirrhosis

https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1002/lt.20386

Alcohol recidivism impairs long-term patient survival after orthotopic liver transplantation for alcoholic liver disease.

BACKGROUND/AIMS Alcoholic cirrhosis remains a controversial indication for liver transplantation, mainly because of ethical considerations related to the shortage of donor livers. The aim of this study was to review experience to date, focusing on survival rates and complications, and the effect of alcohol relapse on outcome and alterations in marital and socioprofessional status. METHODS The results for 53 patients transplanted for alcoholic cirrhosis between 1989 and 1994 were compared with those for 48 patients transplanted for non-alcoholic liver disease. The following variables were analysed: survival, rejection, infection, cancer, retransplantation, employment and marital status, alcoholic recurrence. The same variables were compared between alcohol relapsers and non-relapsers. RESULTS Recovery of employment was the only significantly different variable between alcoholic (30%) and non-alcoholic patients (60%). Two factors influenced survival in the absence of alcohol recidivism: age and abstinence before transplantation. For all other variables, there were no differences between alcoholic and non-alcoholic patients, and, within the alcoholic group, between relapsers and non-relapsers. The recidivism rate was 32%. CONCLUSION The data indicate that liver transplantation is justified for alcoholic cirrhosis, even in cases of recidivism, which did no affect survival and compliance with the immunosuppressive regimen. These good results should help in educating the general population about alcoholic disease.

https://gut.bmj.com/content/gutjnl/45/3/421.full.pdf

Alcoholic cirrhosis is a good indication for liver transplantation, even for cases of recidivism

PURPOSE: To assess computed tomography (CT) with iodized oil for depiction of small hepatocellular carcinoma (HCC) before liver transplantation. MATERIALS AND METHODS: Thirty-five consecutive cirrhotic patients underwent CT with iodized oil to determine the presence, number, size, and location of possible nodules. All patients underwent liver transplantation within 4 months after CT. Explanted livers were cut in 8-mm slices that corresponded to axial CT scan planes. Comparison between CT staging and pathologic findings was made. RESULTS: Pathologic studies showed 17 HCC nodules (diameter, 0.9-4.0 cm) in nine of the 35 livers. CT depicted nine of these 17 nodules. Lesion-by-lesion analysis revealed a sensitivity of 53%; CT falsely depicted three additional nodules not confirmed with pathologic findings. Patient-by-patient analysis revealed an 89% sensitivity and an 88% specificity. CONCLUSION: CT with iodized oil, when assessed lesion by lesion, has a low sensitivity. These results must be considered when ...

Small hepatocellular carcinoma in patients undergoing liver transplantation: detection with CT after injection of iodized oil.

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Alcoholic cirrhosis is a good indication for liver transplantation, even for cases of recidivism

Small hepatocellular carcinoma in patients undergoing liver transplantation: detection with CT after injection of iodized oil.