Acute alcoholic hepatitis, end stage alcoholic liver disease and liver transplantation: An Italian position statement

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 respond-ing 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.