PubMed · 7908075
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A D Thomson. 1994-04-02. Alcoholic hepatitis.. https://doi.org/10.1016/s0140-6736(94)92022-2
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Alcoholic liver disease represents about 15% of all indications for liver transplantation. Patient selection is difficult, and must be rigorous. Peri-operative risks are evaluated on the same basis as for other chronic liver diseases, with special attention for alcoholic extra-hepatic morbidity and nutritional status. Definite withdrawal from alcohol is mandatory. Predictive factors of long-term abstinence are the absence of psychopathologic state, an adequate social and affective situation, the possibilities of professional reinsertion, and a strong motivation of the patient towards liver transplantation. A six-month period of complete abstinence before registration on a liver transplantation waiting list is not mandatory, although intermittent alcoholic abuse before transplantation should be an exclusion factor. Liver transplantation must be proposed based on the severity of liver failure, as assessed by pronostic scores. It must be rapidly discussed following an acute episode of decompensation, in the absence of a significant improvement despite adequate medical therapy. It must also be discussed for long-term abstinent patients, with an apparently stabilized cirrhosis, but with an important decrease of the functional liver mass. The evaluation of the functional liver mass is based upon the Child-Pugh score, associated with the results of metabolic liver function tests, the measurement of the hepatic volume and the severity of portal hypertension.
OBJECTIVES: to determine whether ursodeoxycholic acid (UDCA) is effective in improving primary biliary cirrhosis (PBC) or chronic hepatitis (CH). METHODS: Meta-analysis (MA) was performed on nine papers and three abstracts describing PBC and on nine papers and two abstracts with CH that were published between 1985 and 1992 and were identified through MEDLINE. Studies were included if they fulfilled established quality criteria and the patients had at least liver histology at the start and two to three relevant laboratory tests repeated after UDCA. A total of 800 patients with PBC were treated for 6-48 months. In CH, 285 patients were treated for 1-21 months. RESULTS: In PBC, an average daily UDCA of 13 mg/kg.day improved the liver tests AST, ALT, ALP, and GGT (all p < 0.001). The effect on serum bilirubin was too heterogeneous to evaluate. When evaluated individually, the studies showed an indeterminate effect on histologic progression and treatment failure. When pooled in MA, UDCA improved the liver histology (p < 0.001) and prevented treatment failure (p < 0.04). In CH, UDCA at an average of 11 mg/kg.day improved AST, ALT, GGT, and total bilirubin (all p < 0.001) and also ALP (p = 0.014). There was no effect on histology of CH and no data on treatment failure. CONCLUSIONS: MA confirmed a beneficial effect of UDCA in PBC on liver tests, histology, and treatment failure. In CH, there was an improvement in liver tests, but the evidence for histologic effect was sparse and insignificant. Future studies in PBC must explore the disease after UDCA is discontinued. Trials in CH should distinguish between the diagnostic subgroups, document patient compliance with UDCA, and include histology and treatment failure as end points.