SNFGE SNFGE
 
Thématique :
- Foie (hors cancers)
Originalité :
Réexamen
Solidité :
A confirmer
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Christine SILVAIN
Coup de coeur :
 
 
Hepatology
  2018/12  
 
  2018 Dec.  
  doi: 10.1002/hep.30478.  
 
  Predicting Low-Risk for Sustained Alcohol Use After Early Liver Transplant for Acute Alcoholic Hepatitis: The SALT Score.  
 
  Lee BP, Vittinghoff E, Hsu C, Han H, Therapondos G, Fix OK, Victor DW, Dronamraju D, Im GY, Voigt MD, Rice JP, Lucey MR, Eswaran S, Chen PH, Li Z, Maddur H, Terrault NA  
  https://www.ncbi.nlm.nih.gov/pubmed/30561766  
 
 

Abstract

Early liver transplant (LT) for alcohol-associated disease (i.e. without a specific sobriety period) is controversial, but increasingly used. Using the multicenter American Consortium of Early Liver Transplantation for Alcoholic Hepatitis (ACCELERATE-AH) cohort, we aimed to develop a predictive tool to identify patients pre-transplant with low-risk for sustained alcohol use post-transplant to inform selection of candidates for early LT candidates. We included consecutive ACCELERATE-AH LT recipients between 2012-2017. All had clinically-diagnosed severe alcoholic hepatitis (AH), no prior diagnosis of liver disease or AH, and underwent LT without a specific sobriety period. Logistic and cox regression, classification and regression trees (CART), and LASSO regression were used to identify variables associated with sustained alcohol use post-LT. Among 134 LT recipients for AH with median abstinence pre-LT of 54 days, 74% were abstinent, 16% had slips only, and 10% had sustained alcohol use after median 1.6 (IQR 0.7-2.8) years follow-up post-LT. Four variables were associated with sustained use of alcohol post-LT, forming the SALT (Sustained Alcohol use post-LT) score (range, 0-11): >10 drinks/day at initial hospitalization (+4 points), multiple prior rehabilitation attempts (+4 points), prior alcohol-related legal issues (+2 points), prior illicit substance abuse (+1 point). C-statistic was 0.76 (95% CI, 0.68-0.83). SALT of ≥5 had 25% PPV (95% CI, 10%-47%) and 95% NPV (95% CI, 89%-98%) for sustained alcohol use post-LT. In internal cross-validation, the average c-statistic was 0.74.

CONCLUSION: A novel prognostic score, the SALT score, using four objective pre-transplant variables identifies AH candidates for early LT at low-risk for sustained alcohol use post-transplant. This tool may assist in the selection of patients with AH for early LT or to guide risk-based interventions post-LT.

 
Question posée
 
Développer un outil prédictif pour identifier les patients en pré-transplantation hépatique ayant un faible risque de continuer l’alcool en post transplantation afin de sélectionner les candidats à une transplantation hépatique précoce.
 
Question posée
 
Les 4 variables du SALT score sont les suivantes: >10 verres/jour au moment de l’hospitalisation initiale (+4 points), tentative de réhabilitations antérieures multiples (+4 points), affaires légales antérieures et liées à l’alcool (+2 points), prise de substances illicites antérieures (+1 point). Un SALT ≥5 a une VPP de 25% (95% CI, 10%-47%) et une VPN de 95% (95% CI, 89%-98%) pour une utilisation prolongée de l’alcool en post –TH.
 
Commentaires

Cet outil associé à la démarche utilisée dans le cadre du PHRC pourrait affiner les critères pour valider la transplantation hépatique rapide des patients ayant une hépatite alcoolique aiguë mais aussi être plus attentif et « interventionniste » chez les patients à fort risque de récidive.

 
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