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Thématique :
- Foie
Originalité :
Réexamen
Solidité :
Très solide
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Christine SILVAIN
Coup de coeur :
 
 
Hepatology
  2019/04  
 
  2019 Apr;69(4):1477-1487.  
  doi: 10.1002/hep.30478.  
 
  Predicting Low Risk for Sustained Alcohol Use After Early Liver Transplant for Acute Alcoholic Hepatitis: The Sustained Alcohol Use Post-Liver Transplant 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 pretransplant with low risk for sustained alcohol use posttransplant to inform selection of candidates for early LT. We included consecutive ACCELERATE-AH LT recipients between 2012 and 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 (CARTs), and least absolute shrinkage and selection operator (LASSO) regression were used to identify variables associated with sustained alcohol use post-LT. Among 134 LT recipients for AH with median period of alcohol abstinence pre-LT of 54 days, 74% were abstinent, 16% had slips only, and 10% had sustained alcohol use after a median 1.6 (interquartile range [IQR]: 0.7-2.8) years follow-up post-LT. Four variables were associated with sustained use of alcohol post-LT, forming the Sustained Alcohol Use Post-LT (SALT) score (range: 0-11): >10 drinks per day at initial hospitalization (+4 points), multiple prior rehabilitation attempts (+4 points), prior alcohol-related legal issues (+2 points), and prior illicit substance abuse (+1 point). The C statistic was 0.76 (95% confidence interval [CI]: 0.68-0.83). A SALT score ≥5 had a 25% positive predictive value (95% CI: 10%-47%) and a SALT score of <5 had a 95% negative predictive value (95% CI: 89%-98%) for sustained alcohol use post-LT. In internal cross-validation, the average C statistic was 0.74. Conclusion: A prognostic score, the SALT score, using four objective pretransplant variables identifies candidates with AH for early LT who are at low risk for sustained alcohol use posttransplant. This tool may assist in the selection of patients with AH for early LT or in guiding risk-based interventions post-LT.

 
 
Question posée
 
Développer un outil prédictif pour identifier en pré-transplantation (TH) hépatiques les patients ayant un faible risque de rechute de prise d’alcool en post-TH pour l'élection des patients avec indication de TH sans période d’abstinence comme les hépatites alcooliques aiguës sévères sans cirrhose, ni prise en charge préalable connue.
 
Question posée
 
Dans la cohorte américaine ACCELERATE-AH, en post-TH, 74% des patients étaient abstinents, 16% avaient des prises occasionnelles, et 10% avaient une récidive soutenue après plus 1,5 ans de suivi post-TH. Le score SALT ( de 0-11) intégrait: >100 g/jour avant la première hospitalisation (+4 points), multiples tentatives de sevrage (+4 points), affaire juridique en relation avec l’alcool (+2 points), et prise de substance illicite (+1 point). Un score SALT <5 avait une valeur prédictive négative de reprise soutenue de l’alcool en post TH de 95% (95% CI: 89%-98%).
 
Commentaires

Un nouveau test intéressant mais à valider dans la population française.

 
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