But early liver transplant improves survival in medically unresponsive severe alcoholic hepatitis
WEDNESDAY, Nov. 9 (HealthDay News) -- For patients with severe acute alcoholic hepatitis, prednisolone plus N-acetylcysteine therapy does not improve six-month survival, but early liver transplant after a first episode of severe alcoholic hepatitis not responding to medical therapy does, according to two studies published in the Nov. 10 issue of the New England Journal of Medicine.
Eric Nguyen-Khac, M.D., Ph.D., from the Amiens University Hospital in France, and colleagues investigated whether combination therapy with glucocorticoids plus N-acetylcysteine would improve survival in patients with acute alcoholic hepatitis. One, three, and six month survivals were compared in 85 and 89 patients on combination therapy and prednisolone alone, respectively. Compared to the prednisolone-only group, mortality in the combination group was significantly lower at one month, but not at three or six months, and there was significantly less frequent hepatorenal syndrome-related mortality at six months.
Philippe Mathurin, M.D., Ph.D. from the Hôpital Claude Huriez in Lille, France investigated whether early liver transplantation improves six-month survival in 26 patients with a first episode of severe alcoholic hepatitis, unresponsive to medical management. Participants had a median Lille score of 0.88, were at high risk of death, and placed on a liver transplant list within a median of 13 days after medical therapy nonresponsiveness. Patients who received early transplantation had a significantly higher cumulative six-month survival rate than those who did not, and this benefit persisted through two years of follow up.
"Early liver transplantation can improve survival in patients with a first episode of severe alcoholic hepatitis not responding to medical therapy," Mathurin and colleagues write.
Several authors from the Mathurin study disclosed financial ties to the pharmaceutical industry.
Full Text - Nguyen-Khac (subscription or payment may be required)
Full Text - Mathurin (subscription or payment may be required)
Editorial (subscription or payment may be required)