Discussion of Mathurin et al's . (2011)
Fig 1: Stages of alcohol-induced liver damage
Note : Cirrhosis caused by several caused included excessive
alcohol intake and hepitits B and C
Objective :
Mathurin
et al. (2011) conducted a research titled "Early Liver Transplantation for Severe Alcoholic
Hepatitis" in response to
the controversial issue regarding early transplantation of liver to patients
who suffer from sever alcoholic
hepatitis.
Controversial issue :
Most centers wait for a period of six months
after abstinence from alcohol before allowing the liver transplantation for two
reasons. The first reason is that high consumption of alcohol is the reason behind the alcoholic hepatitis so the patients are responsible
for their illness. The other reason is that the centers need to assess the
patient's ability to stop consumption of alcohol and their appropriateness
for transplantation .The major problem
of this is that the survival rate of
patients whose alcoholic hepatitis that is resistant to medical treatment is approximately 30%.
Research questions :
Mathurin
et al. (2011) article aimed to evaluate the effect of early liver
transplantation , without waiting 6 month after abstinence from alcohol, on the survival rate and the
percentage of alcohol relapse of
alcoholic hepatitis- patients who didn't
response to the treatment ( by
Glucocorticoids ).In addition ,the
research assessed the
effect early liver
transplantation on the whole level of
transplantation activity of the participated centers.
Method:
Patients
with severe alcoholic hepatitis( Maddrey's discriminant function is larger than 32) that is resistant to medical treatments and
at high risk of death in the absence of transplantation (Lille model score≥0.45
after constant rise in the Model for End-Stage Liver Disease (MELD) score or
after 7 days of treatment).Written
informative consent were given to the selected groups .
Participants were divided in to two groups : matched group
who didn't undergo early liver transplantation (20) and experimental group that involve patients who undergo transplantation ( 26
patients ) .
Survival rate were compared between two groups to
assess the effect of early liver transplantation .
Result:
Mathurin et al. (2011) showed that early liver transplantation is beneficial for
patients with severe acute alcoholic hepatitis that is not responsive to medical treatment.
The survival rate of patients who undergo the early liver transplant were much
higher than that of matched group . 18 out of 20 patients in the control
group died after two months after
recognition of resistant to treatment. On the other hand ,6 out of 26 patients
died within two weeks after transplantation. Five out of six deaths were
related to infection . Though most centers use 6-month abstinence rule as
predictor of the alcohol relapse after the transplantation , the research
findings challenge the 6-month abstinence rule .Participants who had early
liver transplant didn't experience alcohol relapse during the first 6 months after the transplantation.
Response to the article
The research
conducted by Mathurin et al. (2011) raised the awareness of benefit of early
liver transplantation for patients with severe alcoholic hepatitis that is
resistant to medical treatment.The study
showed that 6 out 26 participants of the
experimental group died after two weeks of transplantation. This represents 23%
of the number of participants . this research indicated that the death of 5 out of these six cases were related to
infection . As a result , preventive measures should be taken in to
account in the future studies .
The
selection process of participants of control group depended on two process of
matching which decreased the investigator bias , the coherent effect , and limit
period .Although this would increase the
validity of the research and the selection process of participant of experimental group ,patients who undergo
transplantation were different in term of the family support and availability of counseling in case of relapses , and the
patients plans to stop alcohol-consumption .As suggested by Mathurin et al. (2011)
, similar social characteristics should be matched between the experimental and
control groups in future studies .
References
Mathurin et al." Early Liver Transplantation for
Severe Alcoholic Hepatitis."The New England Journal of Medicine 365(2011):1790-1800. DOI: 10.1056/NEJMoa1105703.
<http://www.nejm.org/doi/full/10.1056/NEJMoa1105703#t=article>
This article makes a good point that earlier transplantation is more effective in treating alcoholic hepatitis, rather than waiting for the 6 months abstinence period. I can definitely see how this would be controversial. The issue that comes to mind for me is the issue of that they brought this disease upon themselves so are they receiving organs over people who have not caused their disease? I'm not saying that the alcoholics don't deserve organs and to get better but I'm not sure they deserve it over someone who hasn't caused the need for a new liver.
ReplyDeleteI actually agree with Melina about who should receive the organ transplantation more. During my HealthCare Ethic class, we went over the issue regarding organ transplantation and liver disease patients which mostly is caused by huge amount of alcohol consumptions. Based on my opinion, I believe that we should let the person that really need the organ transplantation to receive the transplantation than someone who abuse alcohol. First of all, they have the choice to not drink, they have the power to limit themselves, yet they abuse that privilege, as a result, they have liver disease. I just think that people that don't drinks should be allow to receive the liver transplantation more. In addition, based on your article, I do agree that early transplantation is a wonderful idea but I felt that this is going to be a difficult problem because getting a liver transplantation takes time. Not alot of people in the United States would donate their liver, unless they are dying, or dead. So generally, time is a big factor for this procedure.
ReplyDeleteIt is very clear to understand the material after read your post. I like the way you put each main points in with a big title and explanation below. Also, the organization is pretty good, which is step by step. The summary you wrote is easy to read, I like it. After read your post, I again a knowledge of liver transplantation. Thank you!
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