Alcoholic liver disease (ALD) encompasses a spectrum of liver conditions caused by prolonged heavy alcohol consumption, from simple fatty liver to alcoholic hepatitis and ultimately cirrhosis. It is entirely preventable and, in its early stages, largely reversible.
The Spectrum of Disease
- Alcoholic fatty liver: Fat accumulates in the liver. Reversible with abstinence.
- Alcoholic hepatitis: Acute inflammation. Can range from mild to severe and life-threatening.
- Alcoholic cirrhosis: Irreversible scarring. The endpoint if alcohol use continues. Can lead to liver failure and liver cancer.
Severe Alcoholic Hepatitis
Severe alcoholic hepatitis is a medical emergency with a 30-day mortality of 30-50%. Patients present with deep jaundice, fever, and liver failure. Treatment includes:
- Complete alcohol cessation
- Corticosteroids (prednisolone) in selected patients
- Nutritional support
- Management of complications
Transplant for Alcoholic Liver Disease
Liver transplant can be offered to patients with end-stage alcoholic cirrhosis who:
- Have maintained confirmed alcohol abstinence for 6 months
- Have adequate social support
- Have committed to permanent abstinence post-transplant
- Have undergone psychological evaluation
Outcomes after transplant in carefully selected patients are excellent.