| 1 | Liver transplantation and alcoholic liver disease:History,controversies,and considerations显示文摘Alcohol consumption accounts for 3.8% of annual global mortality worldwide, and the majority of these deaths are due to alcoholic liver disease(ALD), mainly alcoholic cirrhosis. ALD is one of the most common indications for liver transplantation(LT). However, it remains a complicated topic on both medical and ethical grounds, as it is seen by many as a 'self-inflicted disease'. One of the strongest ethical arguments against LT for ALD is the probability of relapse. However, ALD remains a common indication for LT worldwide. For a patient to be placed on an LT waiting list, 6 mo of abstinence must have been achieved for most LT centers. However, this '6-mo rule' is an arbitrary threshold and has never been shown to affect survival, sobriety, or other outcomes. Recent studies have shown similar survival rates among individuals who undergo LT for ALD and those who undergo LT for other chronic causes of end-stage liver disease. There are specific factors that should be addressed when evaluating LT patients with ALD because these patients commonly have a high prevalence of multisystem alcohol-related changes. Risk factors for relapse include the presence of anxiety or depressive disorders, short pre-LT duration of sobriety, and lack of social support. Identification of risk factors and strengthening of the social support system may decrease relapse among these patients. Family counseling for LT candidates is highly encouraged to prevent alcohol consumption relapse. Relapse has been associated with unique histopathological changes, graft damage, graft loss, and even decreased survival in some studies. Research has demonstrated the importance of a multidisciplinary evaluation of LT candidates. Complete abstinence should be attempted to overcome addiction issues and to allow spontaneous liver recovery. Abstinence is the cornerstone of ALD therapy. Psychotherapies, including 12-step facilitation therapy, cognitive-behavioral therapy, and motivational enhancement therapy, help support abstinence. Nutritional therapy helps to reverse muscle wasting, weight loss, vitamin deficiencies, and trace element deficiencies associated with ALD. For muscular recovery, supervised physical activity has been shown to lead to a gain in muscle mass and improvement of functional activity. Early LT for acute alcoholic hepatitis has been the subject of recent clinical studies, with encouraging results in highly selected patients. The survival rates after LT for ALD are comparable to those of patients who underwent LT for other indications. Patients that undergo LT for ALD and survive over 5 years have a higher risk of cardiorespiratory disease, cerebrovascular events, and de novo malignancy. | Claudio Augusto Marroni Alfeu de Medeiros Fleck Jr Sabrina Alves Fernandes Lucas Homercher Galant Marcos Mucenic Mario Henrique de Mattos Meine Guilherme Mariante-Neto Ajacio Bandeira de Mello Brandao | 2018 | World Journal of Gastroenterology2018，24，26： | 7 |
| 2 | Cardiac stress testing and coronary artery disease in liver transplantation candidates: Meta-analysis显示文摘AIM To evaluate the diagnostic value of dobutamine stress echocardiography(DSE) and myocardial perfusion scintigraphy(MPS) in predicting coronary artery disease(CAD) in cirrhotic patients listed for liver transplantation(LT), using invasive coronary angiography(ICA) as gold-standard.METHODS Retrieval of studies was based on Medical Subject Headings and Health Sciences Descriptors, which were combined using Boolean operators. Searches were run on the electronic databases Scopus, Web of Science, EMBASE, MEDLINE(PubMed), BIREME(Biblioteca Regional de Medicina), LILACS(Latin American and Caribbean Health Sciences Literature), Cochrane Library for Systematic Reviews and Opengray.eu. There was no language or date of publication restrictions. The reference lists of the studies retrieved were searched manually.RESULTS The search strategy retrieved 322 references for DSE and 90 for MPS. In the final analysis, 10 references for DSE and 10 for MPS were included. Pooled sensitivity was 28% and 61% for DSE and MPS and specificity was 82% and 74%, for diagnosis of CAD using ICA as gold-standard, respectively.CONCLUSION DSE and MPS do not have adequate sensitivity for determination of whether CAD is present, despite having significant specificity. | Jonathan Soldera Fábio Camazzola Santiago Rodríguez Ajacio Brandao | 2018 | World Journal of Hepatology2018，10，11： | 3 |
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