Letters To The Editor
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 14, 2015; 21(14): 4423-4426
Published online Apr 14, 2015. doi: 10.3748/wjg.v21.i14.4423
Six month abstinence rule for liver transplantation in severe alcoholic liver disease patients
Aiman Obed, Steffen Stern, Anwar Jarrad, Thomas Lorf
Aiman Obed, Anwar Jarrad, Hepatobiliary and Liver Transplant Unit, Jordan Hospital, Amman 11152, Jordan
Steffen Stern, Fakultät für Rechtswissenschaft, Universität Bielefeld, 33615 Bielefeld, Germany
Thomas Lorf, Georg-August-University Goettingen, D-37073 Gottingen, Germany
Author contributions: All authors contributed to data analysis and the interpretation of papers mentioned in this manuscript, as well as drafting the manuscript, making critical revisions, and giving final approval of the version to be published.
Conflict-of-interest: The authors declare no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Aiman Obed, MD FACS, FEBBS, Hepatobiliary and Liver Transplant Unit, Jordan Hospital, PO Box 520248, Amman 11152, Jordan. aimanobed@hotmail.com
Telephone: +962-6-4608080 Fax: +962-6-4607575
Received: November 29, 2014
Peer-review started: December 1, 2014
First decision: December 26, 2014
Revised: January 1, 2015
Accepted: January 30, 2015
Article in press: January 30, 2015
Published online: April 14, 2015
Abstract

Alcoholic liver disease (ALD) is the second most common diagnosis among patients undergoing liver transplantation (LT). The recovery results of patients transplanted for ALD are often at least as good as those of patients transplanted for other diagnoses and better than those suffering from hepatitis C virus, cryptogenic cirrhosis, or hepatocellular carcinoma. In the case of medically non-responding patients with severe acute alcoholic hepatitis or acute-on chronic liver failure, the refusal of LT is often based on the lack of the required alcohol abstinence period of six months. The obligatory abidance of a period of abstinence as a transplant eligibility requirement for medically non-responding patients seems unfair and inhumane, since the majority of these patients will not survive the six-month abstinence period. Data from various studies have challenged the 6-mo rule, while excellent survival results of LT have been observed in selected patients with severe alcoholic hepatitis not responding to medical therapy. Patients with severe advanced ALD should have legal access to LT. The mere lack of pre-LT abstinence should not be an obstacle for being listed.

Keywords: Alcohol, Alcoholic hepatitis, Cirrhosis, Six month abstinence rule, Abstinence, Liver transplantation

Core tip: Severe alcoholic liver diseases that do not respond to medical therapy, such as alcoholic hepatitis or acute-on chronic liver failure, show life threatening one-year mortality rates of up to 90%. The majority of transplant centers demand 6-mo of alcohol abstinence prior to transplantation, the so-called “6-mo rule”. This rule is void of scientific evidence and frequently the subject of controversial discussions. Since most patients with severe alcoholic liver disease will die before meeting the criteria of the 6-mo period of abstinence, liver transplantation has to be taken into account irrespective of the 6-mo abstinence period.