Early Liver Transplantation for Severe Alcoholic ...

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Feb 2, 2012 -
correspondence

tients with severe alcoholic hepatitis who were treated with glucocorticoids was no higher than it was in a control group of patients with cirrhosis who were not treated with glucocorticoids.5 It is time to move on to other questions, as we have done by showing an improvement in early survival by combining glucocorticoids with N-acetylcysteine. In our study, there were fewer deaths from the hepatorenal syndrome and fewer infections in the group treated with glucocorticoids plus N-acetylcysteine as compared with the group treated with glucocortiThe Authors Reply: Since 1978, when patients coids alone. with severe alcoholic hepatitis were first identi- Eric Nguyen-Khac, M.D., Ph.D. fied with the use of Maddrey’s discriminant Amiens University Hospital function (with a value greater than 32 indicating Amiens, France severe disease), the evidence has been growing Thierry Thevenot, M.D., Ph.D. that survival is improved by treatment with gluUniversity Hospital 1 cocorticoids. Even a negative meta-analysis, in Besançon Besançon, France 2 addition to a reanalysis of a negative trial, reported better survival when the discriminant Marie-Astrid Piquet, M.D., Ph.D. function was used to identify patients with se- Caen University Hospital Caen, France vere disease. The American Association for the Since publication of their article, the authors report no furStudy of Liver Disease has issued clear guidelines ther potential conflict of interest. 3 for the use of glucocorticoids. In a prospective study,4 246 patients with severe alcoholic hepati- 1. Rambaldi A, Saconato HH, Christensen E, Thorlund K, Wettis were treated with glucocorticoids. The overall terslev J, Gluud C. Systematic review: glucocorticosteroids for alcoholic hepatitis — a Cochrane Hepato-Biliary Group systemincidence of infections after treatment was atic review with meta-analyses and trial sequential analyses of 23.7%. However, in the patients with a treatment randomized clinical trials. Aliment Pharmacol Ther 2008;27: response (defined according to the Lille model, 1167-78. 2. Mathurin P, Mendenhall CL, Carithers RL Jr, et al. Corticoin which a score of