Validation of the Procedure of Early Liver Transplantation in Alcoholic Hepatitis Resisting to Medical Treatment

Validation of an Accelerated Procedure of Selection in Early Liver Transplantation for Severe Alcoholic Hepatitis Not Responding to Medical Treatment QuickTransHAA.

The purpose of this study is to validate a strategy of identification of patients for early liver transplantation in severe alcoholic hepatitis. In this setting, short-term survival is very low (approx. 25% at 6 months) and a pilot study has suggested (mathurin et al. N Engl J Med 2011) that liver transplantation may be an option in very carefully selected patients who did not respond to medical treatment. This selection process deserves to be confirmed in a population of greater size. We hypothesized that patients selected with this process would have a same alcohol relapse rate after liver transplantation than patients transplanted for alcoholic cirrhosis and selected using a 6-month sobriety period

Non-inferiority of alcohol relapse in early liver transplantation for severe alcoholic hepatitis as compared to patients transplanted for alcoholic cirrhosis.

Inclusion Criteria (Group A):

• Age > 18 years
• Maddrey score > 32
• Liver biopsy confirming the diagnosis of alcoholic hepatitis
• Non-response to medical treatment: Lille score ≥ 0.45 at day 7, or early worsening of liver function (MELD score > 25) despite a low Lille score (< 0.45)
• Hospitalization stay < 1 month
• Algorithm score ≥ 220/250.

Inclusion Criteria (Group B):

• Age >18 years
• Diagnosis of alcoholic cirrhosis
• Alcoholic withdrawal of 6 months minimum before inscription on the transplant list
• MELD score ≥ 15 for patients with hepatocellular carcinoma responding to Milan criteria (1 node < 5 cm or 3 nodes < 3 cm)
• MELD score ≥ 20 preferably for patients not displaying hepatocellular carcinoma and that did not obtain an "expert" component
• No recommendation of MELD score for patients having obtained an "expert" component

Non-inclusion Criteria (Group A and B):

• Bacterial or viral infection uncontrolled by medical treatment
• Fungal or aspergillosis uncontrolled infection
• Hepatocellular carcinoma or invasive cancer
• Positive test for HBsAg, Positive test for HIV,Positive PCR for HCV
• Portal thrombosis
• Pregnancy or breast-feeding woman