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Editorial

Ann Liver Transplant 2024; 4(2): 40-41

Published online November 30, 2024 https://doi.org/10.52604/alt.24.0021

Copyright © The Korean Liver Transplantation Society.

Liver transplantation for alcohol-related liver disease in Korea: The need for patient management guidelines

Soon Kyu Lee

Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Catholic University of Korea, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

Correspondence to:Soon Kyu Lee
Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Catholic University of Korea, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea
E-mail: blackiqq@catholic.ac.kr
https://orcid.org/0000-0003-1865-8225

Received: October 6, 2024; Revised: October 6, 2024; Accepted: October 9, 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/bync/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

See original paper on 95

Liver transplantation (LT) is the definitive treatment option for patients with end-stage liver disease and early hepatocellular carcinoma who meet the criteria established by various groups [1,2]. In selected cases, LT can also be considered for patients with giant hepatic hemangioma or hepatic epithelioid hemangioendothelioma [3,4]. Alcohol-associated liver disease (ALD) is one of the leading causes of LT worldwide. However, there is limited data on the characteristics of ALD patients across different centers and regions in Korea. Additionally, current strategies for managing ALD patients before and after LT are not well documented.

In this context, Choi et al. [5] investigated the characteristics of different centers and regional differences in ALD-LT by analyzing data from 19 centers across Korea. The authors effectively identified the rates of ALD-LT according to center and region. They demonstrated that approximately 20%–37% of patients undergoing LT were treated for ALD across centers, although some centers performed fewer ALD-LT cases compared to others. These findings were consistently observed across regions in Korea. This underscores the need for a comprehensive management strategy for patients undergoing ALD-LT.

This study also investigated the perioperative management protocols in Korea, including the alcohol abstinence period and treatment protocols for alcohol consumption. Interestingly, about half of the centers performing LT required a minimum alcohol abstinence period of 1–6 months before transplantation, and only 10%–20% of centers had formal management protocols for alcohol consumption either before or after LT. Indeed, pre-transplant abstinence and the risk of post-transplant alcohol relapse are critical considerations when performing LT in ALD patients, yet there is significant disparity in pre-transplant abstinence practices across regions and countries [2]. The recent guideline from Asian Pacific Association for Study of Liver suggest that while alcohol abstinence is preferable, the strict 3 to 6 months abstinence rule should be applied with a center-specific approach [2]. Moreover, considering that several guidelines have been proposed for the indication and post-transplantation management of patients with non-alcoholic fatty liver disease and de novo malignancy after LT [6-8], the development of nationwide management guidelines for ALD-LT is crucial to improve patient outcomes.

In conclusion, Choi et al. [5] effectively demonstrated the current varied strategies for ALD-LT in Korea. This study also highlights the need for developing consistent management guidelines for ALD-LT to improve outcomes for liver transplant patients in Korea.

This study received financial support of the Catholic Medical Center Research Foundation made in the program year of 2024 (SKL). This work was also supported by the technology innovation program (or industrial strategic technology development program) (20024163, development of microbiome-based treatment technology to improve the treatment and prognosis of liver transplant patients) funded by the Ministry of Trade, Industry & Energy (MOTIE, Korea) (SKL). This work was also supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (Ministry of Science and ICT, MSIT) (RS-2024-00451810).

Soon Kyu Lee is an editorial member of the journal but was not involved in the review process of this manuscript.

  1. Sha M, Wang J, Cao J, Zou ZH, Qu XY, Xi ZF, et al. Criteria and prognostic models for patients with hepatocellular carcinoma undergoing liver transplantation. Clin Mol Hepatol 2024. https://doi.org/10.3350/cmh.2024.0323 [Epub ahead of print]
    KoreaMed CrossRef
  2. Kim DS, Yoon YI, Kim BK, Choudhury A, Kulkarni A, Park JY, et al; for Asian Pacific Association for Study of Liver (APASL). Asian Pacific Association for the Study of the Liver clinical practice guidelines on liver transplantation. Hepatol Int 2024;18:299-383.
    Pubmed CrossRef
  3. Pack CS, Chung YK. Liver transplantation for giant hepatic hemangioma: a collective review. Ann Liver Transplant 2023;3:69-72.
    CrossRef
  4. Park JI, Jung BH. Liver transplantation for hepatic epithelioid hemangioendothelioma: a review of European and Korean experience. Ann Liver Transplant 2023;3:6-10.
    CrossRef
  5. Choi HH, Lee KW, Kim BW, Kim DS, Choi GS, Lee HW, et al. Varied strategies for alcohol-related liver transplants in South Korea. Ann Liver Transplant 2024;4:95-101.
    CrossRef
  6. Battistella S, D'Arcangelo F, Grasso M, Zanetto A, Gambato M, Germani G, et al. Liver transplantation for non-alcoholic fatty liver disease: indications and post-transplant management. Clin Mol Hepatol 2023;29:S286-S301.
    Pubmed KoreaMed CrossRef
  7. Song BG, Sinn DH. How to optimize the outcome of liver transplantation for non-alcoholic fatty liver disease. Clin Mol Hepatol 2023;29:411-413.
    Pubmed KoreaMed CrossRef
  8. Kang WH. Surveillance and management of de novo malignancy after liver transplantation. Ann Liver Transplant 2024;4:10-15.
    CrossRef

Article

Editorial

Ann Liver Transplant 2024; 4(2): 40-41

Published online November 30, 2024 https://doi.org/10.52604/alt.24.0021

Copyright © The Korean Liver Transplantation Society.

Liver transplantation for alcohol-related liver disease in Korea: The need for patient management guidelines

Soon Kyu Lee

Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Catholic University of Korea, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

Correspondence to:Soon Kyu Lee
Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Catholic University of Korea, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea
E-mail: blackiqq@catholic.ac.kr
https://orcid.org/0000-0003-1865-8225

Received: October 6, 2024; Revised: October 6, 2024; Accepted: October 9, 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/bync/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Body

See original paper on 95

Liver transplantation (LT) is the definitive treatment option for patients with end-stage liver disease and early hepatocellular carcinoma who meet the criteria established by various groups [1,2]. In selected cases, LT can also be considered for patients with giant hepatic hemangioma or hepatic epithelioid hemangioendothelioma [3,4]. Alcohol-associated liver disease (ALD) is one of the leading causes of LT worldwide. However, there is limited data on the characteristics of ALD patients across different centers and regions in Korea. Additionally, current strategies for managing ALD patients before and after LT are not well documented.

In this context, Choi et al. [5] investigated the characteristics of different centers and regional differences in ALD-LT by analyzing data from 19 centers across Korea. The authors effectively identified the rates of ALD-LT according to center and region. They demonstrated that approximately 20%–37% of patients undergoing LT were treated for ALD across centers, although some centers performed fewer ALD-LT cases compared to others. These findings were consistently observed across regions in Korea. This underscores the need for a comprehensive management strategy for patients undergoing ALD-LT.

This study also investigated the perioperative management protocols in Korea, including the alcohol abstinence period and treatment protocols for alcohol consumption. Interestingly, about half of the centers performing LT required a minimum alcohol abstinence period of 1–6 months before transplantation, and only 10%–20% of centers had formal management protocols for alcohol consumption either before or after LT. Indeed, pre-transplant abstinence and the risk of post-transplant alcohol relapse are critical considerations when performing LT in ALD patients, yet there is significant disparity in pre-transplant abstinence practices across regions and countries [2]. The recent guideline from Asian Pacific Association for Study of Liver suggest that while alcohol abstinence is preferable, the strict 3 to 6 months abstinence rule should be applied with a center-specific approach [2]. Moreover, considering that several guidelines have been proposed for the indication and post-transplantation management of patients with non-alcoholic fatty liver disease and de novo malignancy after LT [6-8], the development of nationwide management guidelines for ALD-LT is crucial to improve patient outcomes.

In conclusion, Choi et al. [5] effectively demonstrated the current varied strategies for ALD-LT in Korea. This study also highlights the need for developing consistent management guidelines for ALD-LT to improve outcomes for liver transplant patients in Korea.

FUNDING

This study received financial support of the Catholic Medical Center Research Foundation made in the program year of 2024 (SKL). This work was also supported by the technology innovation program (or industrial strategic technology development program) (20024163, development of microbiome-based treatment technology to improve the treatment and prognosis of liver transplant patients) funded by the Ministry of Trade, Industry & Energy (MOTIE, Korea) (SKL). This work was also supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (Ministry of Science and ICT, MSIT) (RS-2024-00451810).

CONFLICT OF INTEREST

Soon Kyu Lee is an editorial member of the journal but was not involved in the review process of this manuscript.

References

  1. Sha M, Wang J, Cao J, Zou ZH, Qu XY, Xi ZF, et al. Criteria and prognostic models for patients with hepatocellular carcinoma undergoing liver transplantation. Clin Mol Hepatol 2024. https://doi.org/10.3350/cmh.2024.0323 [Epub ahead of print]
    KoreaMed CrossRef
  2. Kim DS, Yoon YI, Kim BK, Choudhury A, Kulkarni A, Park JY, et al; for Asian Pacific Association for Study of Liver (APASL). Asian Pacific Association for the Study of the Liver clinical practice guidelines on liver transplantation. Hepatol Int 2024;18:299-383.
    Pubmed CrossRef
  3. Pack CS, Chung YK. Liver transplantation for giant hepatic hemangioma: a collective review. Ann Liver Transplant 2023;3:69-72.
    CrossRef
  4. Park JI, Jung BH. Liver transplantation for hepatic epithelioid hemangioendothelioma: a review of European and Korean experience. Ann Liver Transplant 2023;3:6-10.
    CrossRef
  5. Choi HH, Lee KW, Kim BW, Kim DS, Choi GS, Lee HW, et al. Varied strategies for alcohol-related liver transplants in South Korea. Ann Liver Transplant 2024;4:95-101.
    CrossRef
  6. Battistella S, D'Arcangelo F, Grasso M, Zanetto A, Gambato M, Germani G, et al. Liver transplantation for non-alcoholic fatty liver disease: indications and post-transplant management. Clin Mol Hepatol 2023;29:S286-S301.
    Pubmed KoreaMed CrossRef
  7. Song BG, Sinn DH. How to optimize the outcome of liver transplantation for non-alcoholic fatty liver disease. Clin Mol Hepatol 2023;29:411-413.
    Pubmed KoreaMed CrossRef
  8. Kang WH. Surveillance and management of de novo malignancy after liver transplantation. Ann Liver Transplant 2024;4:10-15.
    CrossRef
The Korean Liver Transplantation Society

Vol.4 No.2
November 2024

pISSN 2765-5121
eISSN 2765-6098

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