Liver transplantation for alcoholic hepatitis. Current situation and future.

Alcoholic hepatitis (AH) is a life-threatening disease, especially in its severe forms, with a 30-40 % mortality rate at 1 month in the absence of treatment. Severe forms are traditionally defined by Maddrey discriminant function >32. Until now, only corticosteroids have provided a significant benefit to survival in severe AH patients. Non-responders to corticosteroid therapy can be identified after 7 days of treatment when the Lille score is above 0.45, and this concerns about 40 % of patients with AH. With so few therapeutic alternatives for severe AH, the debate on liver transplantation (LT) has reopened. However, the latter indication for LT is facing several difficulties such as the 6-month abstinence rule ordinarily required for alcoholic diseases, risk of alcohol relapse and comprehensive fear of a drop in donations. Inversely, transplanted AH patients have a significantly improved survival, and an excess risk of alcohol relapse has not been demonstrated. Solutions can certainly be found in order to improve severe AH survival without causing a loss of opportunity for LT for other indications by good selection according to strict criteria.