Postgraduate Course at DDW: Complete Clinical Updates for Today's Practice

7_Mellinger PGC- ALCHEP FINAL

Pdf Summary

In the 2025 presentation by Dr. Jessica L. Mellinger from Henry Ford Health and Michigan State University, the discussion centers on the management of severe alcohol-associated hepatitis (AAH). Key objectives include understanding when to consider early liver transplantation, best practices for alcohol use interventions, and the utilization of alcohol use disorder (AUD) medications pre- and post-transplant.<br /><br />AAH is identified by a rapid onset of jaundice and liver failure due to prolonged heavy alcohol use, but it is distinct from acute liver failure. Key diagnostic markers include elevated AST levels, a high AST:ALT ratio, and significant bilirubin and INR levels.<br /><br />Prognosis in AAH is gauged using scores such as Maddrey’s Discriminant Function, which indicates severe survival outcomes, and the MELD score, with higher scores suggesting poorer prognosis. Corticosteroids, notably prednisolone, form a component of current therapies, though side effects like infection and psychiatric issues are notable risks. The timing of steroid administration is not as urgent as antibiotics for sepsis, as improvement may sometimes be seen without immediate intervention.<br /><br />A crucial therapeutic strategy includes complete alcohol abstinence. Early AUD treatment, incorporating attendance at rehab and pharmaceutical interventions, can significantly improve patient outcomes. Careful consideration is needed for AUD medications post-liver transplantation, particularly in monitoring renal function and avoiding drug interactions.<br /><br />Integrated care programs, which combine medical and psychological treatment, show promise by improving logistics and reducing stigma. Liver transplantation for alcohol-associated hepatitis is increasingly common, though the risk of alcohol relapse post-transplant remains a concern, contributing to a discussion on equity in liver transplant candidacy.<br /><br />The presentation concludes with the importance of early referral for liver transplantation when prognosis is poor, understanding local liver transplant center criteria, and cautious use of AUD relapse medications.

Keywords

Alcohol-associated hepatitis

Liver transplantation

Alcohol use disorder

Maddrey’s Discriminant Function

Corticosteroids

Alcohol abstinence

Integrated care programs

Prognosis

Renal function

Equity in transplant