Journal
NATURE REVIEWS GASTROENTEROLOGY & HEPATOLOGY
Volume 19, Issue 1, Pages 45-59Publisher
NATURE PORTFOLIO
DOI: 10.1038/s41575-021-00527-0
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Funding
- Fondo Nacional de Desarrollo Cientifico y Tecnologico [FONDECYT 1200227]
- Comision Nacional de Investigacion Cientifica y Tecnologica (CONICYT) [AFB170005]
- NIH - NIDA Intramural Research Program [ZIA-DA000635, ZIA-AA000218]
- NIH - NIAAA Division of Intramural Clinical and Biological Research [ZIA-DA000635, ZIA-AA000218]
- grant - Alcoholic Hepatitis Clinical and Translational Network Late Phase Clinical Trials and Observational Studies [AA26974-01]
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This review discusses the management of alcohol use disorder in patients with alcohol-associated liver disease, particularly in the setting of liver transplantation. It emphasizes the importance of a multidisciplinary approach, including diagnosis, predictors of relapse, behavioral and pharmacological therapies. The review also proposes a comprehensive definition of relapse using contemporary biomarkers to guide future clinical trials for optimizing treatment, transplant selection, and post-transplant care of patients with AUD and cirrhosis.
In this Review, Arab and colleagues discuss management of alcohol use disorder in patients with alcohol-associated liver disease, particularly in the setting of liver transplantation. An integrative, multidisciplinary approach is proposed. The prevalence of alcohol use disorder (AUD) has been steadily increasing over the past decade. In parallel, alcohol-associated liver disease (ALD) has been increasing at an alarming rate, especially among young patients. Data suggest that most patients with ALD do not receive AUD therapy. Although liver transplantation is the only curative therapy for end-stage ALD, transplant candidacy is often a matter of debate given concerns about patients being under-treated for AUD and fears of post-transplantation relapse affecting the allograft. In this Review, we discuss diagnosis, predictors and effects of relapse, behavioural therapies and pharmacotherapies, and we also propose an integrative, multidisciplinary and multimodality approach for treating AUD in patients with cirrhosis, especially in the setting of liver transplantation. Notably, this approach takes into account the utility of AUD pharmacotherapy in patients on immunosuppressive medications and those with renal impairment after liver transplantation. We also propose a comprehensive and objective definition of relapse utilizing contemporary biomarkers to guide future clinical trials. Future research using the proposed approach and definition is warranted with the goal of optimizing AUD treatment in patients with cirrhosis, the transplant selection process and post-transplantation care of patients with AUD.
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