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ALCOHOL-RELATED LIVER DISEASE
Treatment Guideline Chart

Alcoholic liver disease diagnosis is suggested by an established history of habitual alcohol intake of sufficient length and intensity.
Signs of alcohol abuse and hepatic injury include malnutrition and muscle wasting, cutaneous telangiectasia, palmar erythema, finger clubbing, Dupuytren's contracture, peripheral neuropathy, parotid gland enlargement and signs of gynecomastia and hypogonadism may also be present. Patient may also be asymptomatic.

 

Surgical Intervention

Liver Transplantation

  • Patients with advanced ALD or end-stage liver disease secondary to ALD cirrhosis (Child-Pugh C or MELD-Na ≥21) may be considered for liver transplantation
    • Sick patients unable to complete rehabilitation therapy may also be considered for liver transplantation and can finish their rehabilitation therapy after surgery
  • May also be considered in select patients with severe alcoholic hepatitis and favorable psychosocial profiles who are unresponsive to medical treatment
  • Survival rate is comparable to patients who had transplantation from nonalcoholic liver disease
    • Patients classified as Child-Pugh C and/or MELD ≥15 gain survival benefit
  • Carefully evaluate the patient for:
    • Ability and commitment to abstain from alcohol, eg abstinence from alcohol of a minimum of 6 months
      • The 6-month abstinence criterion alone should not be used as a basis in patient selection as evidence to document its validity in predicting alcohol relapse is limited 
    • Damage to other organs (eg heart, brain)
    • Malignancy in the upper gastrointestinal tract or the upper airways
  • Immunosuppressive agents (eg Sirolimus or Everolimus) should be used at the lowest effective dose for prevention of graft rejection  
  • Screen posttransplant patients during each follow-up for use of alcohol and other substances (eg cannabis, tobacco) 
  • Transjugular intrahepatic portosystemic shunt (TIPS) may be used to treat refractory ascites secondary to cirrhosis and as a bridge to liver transplantation
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