Model to Calculate Harms and Benefits of Early vs Delayed Liver Transplantation for Patients With Alcohol-Associated Hepatitis
| العنوان: | Model to Calculate Harms and Benefits of Early vs Delayed Liver Transplantation for Patients With Alcohol-Associated Hepatitis |
|---|---|
| المؤلفون: | Ethan M. Weinberg, George Therapondos, Christine Hsu, Sumeyye Samur, Gene Y. Im, Jagpreet Chhatwal, Norah A. Terrault, Emily D. Bethea, Michael D. Voigt, David W. Victor, Hyosun Han, Brian Lee, Oren K. Fix, Michael R. Lucey, Mary E. Rinella, Ozden O. Dalgic, Sheila Eswaran |
| المصدر: | Gastroenterology, vol 157, iss 2 Gastroenterology |
| بيانات النشر: | eScholarship, University of California, 2019. |
| سنة النشر: | 2019 |
| مصطلحات موضوعية: | Male, Pediatrics, Time Factors, medicine.medical_treatment, drinking, Liver transplantation, Severity of Illness Index, Oral and gastrointestinal, Hepatitis, Liver disease, Substance Misuse, Alcohol Use and Health, Model for End-Stage Liver Disease, Models, Prospective Studies, Prospective cohort study, media_common, Alcohol Abstinence, Liver Disease, Gastroenterology, Middle Aged, Alcoholic, Alcoholism, surgical procedures, operative, Treatment Outcome, Female, Adult, medicine.medical_specialty, Alcohol Drinking, Waiting Lists, media_common.quotation_subject, Chronic Liver Disease and Cirrhosis, Clinical Sciences, Models, Biological, Risk Assessment, Article, Time-to-Treatment, End Stage Liver Disease, Paediatrics and Reproductive Medicine, Sobriety, Life Expectancy, Clinical Research, medicine, Humans, Transplantation, Hepatology, Gastroenterology & Hepatology, business.industry, Hepatitis, Alcoholic, Prevention, Neurosciences, 6-month rule, Organ Transplantation, Abstinence, medicine.disease, Biological, Survival Analysis, Markov model, Liver Transplantation, Good Health and Well Being, business, Digestive Diseases, ACCELERATE-AH |
| الوصف: | Background & aimsEarly liver transplantation (without requiring a minimum period of sobriety) for severe alcohol-associated hepatitis (AH) is controversial: many centers delay eligibility until a specific period of sobriety (such as 6 months) has been achieved. To inform ongoing debate and policy, we modeled long-term outcomes of early vs delayed liver transplantation for patients with AH.MethodsWe developed a mathematical model to simulate early vs delayed liver transplantation for patients with severe AH and different amounts of alcohol use after transplantation: abstinence, slip (alcohol use followed by sobriety), or sustained use. Mortality of patients before transplantation was determined by joint-effect model (based on Model for End-Stage Liver Disease [MELD] and Lille scores). We estimated life expectancies of patients receiving early vs delayed transplantation (6-month wait before placement on the waitlist) and life years lost attributable to alcohol use after receiving the liver transplant.ResultsPatients offered early liver transplantation were estimated to have an average life expectancy of 6.55 life years, compared with an average life expectancy of 1.46 life years for patients offered delayed liver transplantation (4.49-fold increase). The net increase in life expectancy from offering early transplantation was highest for patients with Lille scores of 0.50-0.82 and MELD scores of 32 or more. Patients who were offered early transplantation and had no alcohol use afterward were predicted to survive 10.85 years compared with 3.62 years for patients with sustained alcohol use after transplantation (7.23life years lost). Compared with delayed transplantation, early liver transplantation increased survival times in all simulated scenarios and combinations of Lille and MELD scores.ConclusionsIn a modeling study of assumed carefullyselected patients with AH, early vs delayed liver transplantation (6months of abstinence from alcohol before transplantation) increased survival times of patients, regardless of estimated risk of sustained alcohol use after transplantation. These findings support early liver transplantation for patients with severe AH. The net increasein life expectancy was maintained in all simulated extreme scenarios but should be confirmed in prospective studies. Sustained alcohol use after transplantation significantly reduced but did not eliminate thebenefits of early transplantation. Strategies are needed toprevent and treat posttransplantation use of alcohol. |
| وصف الملف: | application/pdf |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::30c9bb737afeb0317eb114c97904a9baTest https://escholarship.org/uc/item/6627q4vfTest |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....30c9bb737afeb0317eb114c97904a9ba |
| قاعدة البيانات: | OpenAIRE |
| الوصف غير متاح. |