Early liver transplantation for severe alcoholic hepatitis
Trial question
What is the role of early liver transplantation in patients with severe alcoholic hepatitis?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
42.0% female
58.0% male
N = 52
52 patients (22 female, 30 male).
Inclusion criteria: patients with no prior episodes of alcoholic hepatitis and had scores of ≥ 0.45 according to the Lille model.
Key exclusion criteria: uncontrolled infection, recent gastrointestinal bleeding, positive for HBV, HCV, and HIV antibodies, and severe psychiatric disorders.
Interventions
N=26 undergoing early liver transplantation (early liver transplantation within a median of 13 days after nonresponse to medical therapy).
N=26 not undergoing liver transplantation (matched patients who did not undergo transplantation).
Primary outcome
Cumulative survival at 6 months
77%
23%
77.0 %
57.8 %
38.5 %
19.3 %
0.0 %
Undergoing early liver
transplantation
Not undergoing liver
transplantation
Significant
increase ▲
NNT = 1
Significant increase in cumulative survival at 6 months (77% vs. 23%; RR 3.35, 95% CI 1.36 to 5.34).
Secondary outcomes
Significant increase in survival at 2 year follow-up, in univariate analysis (71% vs. 23%; RR 3.09, 95% CI 1.26 to 4.92).
Conclusion
In patients with no prior episodes of alcoholic hepatitis and had scores of ≥ 0.45 according to the Lille model, undergoing early liver transplantation was superior to not undergoing liver transplantation with respect to cumulative survival at 6 months.
Reference
Mathurin P, Moreno C, Samuel D et al. Early liver transplantation for severe alcoholic hepatitis. N Engl J Med. 2011 Nov 10;365(19):1790-800.
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