{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T03:33:30Z","timestamp":1792035210394,"version":"4.4.0"},"reference-count":36,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2024,7,25]],"date-time":"2024-07-25T00:00:00Z","timestamp":1721865600000},"content-version":"vor","delay-in-days":24,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background &amp; aims<\/jats:title><jats:p>Severe alcohol\u2010associated hepatitis (SAH) represents a lethal subset of alcohol\u2010associated liver disease. Although corticosteroids are recommended by guidelines, their efficacy and safety remain questionable and so liver transplantation (LT) has been increasingly utilized. The timing and indication of corticosteroid use, specifically in patients being considered for LT requires further clarification.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective analysis was conducted on 256 patients with SAH between 2018 and 2022 at a single US center.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twenty of these patients underwent LT. Of the 256 patients, 38% had what we termed \u201ccatastrophic\u201d SAH, defined as a MELD\u2010Na \u226535 and\/or discriminant function (DF) \u2265100, which carried a mortality of 90% without LT. Compared with 100 matched controls, patients undergoing LT exhibited a one\u2010year survival rate of 100% versus 35% (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.0005). LT provided an absolute risk reduction of 65%, with a number needed to treat of 1.5. Steroid utilization in the entire cohort was 19% with 60% developing severe complications. Patients administered steroids were younger with lower MELD and DF scores. Only 10% of those prescribed steroids derived a favorable response. Sustained alcohol use post\u2010LT was 20%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We propose ELFSAH: Expedited LT as <jats:italic>First Line Therapy<\/jats:italic> for SAH; challenging the current paradigm with recommendations to defer steroids in patients with \u201ccatastrophic\u201d SAH (defined as: MELD\u2010Na \u226535 and\/or DF \u2265100). Patients should be seen urgently by hepatology, transplant surgery, psychiatry and social work. Patients without an absolute contraindication should be referred for LT as first\u2010line therapy during their index admission.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ctr.15340","type":"journal-article","created":{"date-parts":[[2024,7,25]],"date-time":"2024-07-25T07:10:49Z","timestamp":1721891449000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Expedited liver transplantation as first\u2010line therapy for severe alcohol hepatitis: ELFSAH; deferring corticosteroids in the sickest subset of patients"],"prefix":"10.1111","volume":"38","author":[{"given":"Nabeeha","family":"Mohy\u2010ud\u2010din","sequence":"first","affiliation":[{"name":"Division of Gastroenterology Hepatology and Nutrition, University of Pittsburgh Medical Center  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fei\u2010Pi","family":"Lin","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Hepatology and Nutrition, University of Pittsburgh Medical Center  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vikrant","family":"Rachakonda","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology University of California Davis School of Medicine Veteran's Association Northern California Healthcare System  Sacramento California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Al\u2010Khafaji","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine University of Pittsburgh Medical Center  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott W.","family":"Biggins","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Hepatology and Nutrition, University of Pittsburgh Medical Center  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Swaytha","family":"Ganesh","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Hepatology and Nutrition, University of Pittsburgh Medical Center  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramon","family":"Bataller","sequence":"additional","affiliation":[{"name":"Liver Unit Hospital Clinic  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"DiMartini","sequence":"additional","affiliation":[{"name":"Department of Psychiatry University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Hughes","sequence":"additional","affiliation":[{"name":"Thomas E. Starzl Transplantation Institute University of Pittsburgh Medical Center  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhinav","family":"Humar","sequence":"additional","affiliation":[{"name":"Thomas E. Starzl Transplantation Institute University of Pittsburgh Medical Center  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9274-999X","authenticated-orcid":false,"given":"Shahid M.","family":"Malik","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Hepatology and Nutrition, University of Pittsburgh Medical Center  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,7,25]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/acer.12887"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.2276"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000001596"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1105703"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.21607"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.30866"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2018.03.018"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1412278"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2018.05.011"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.16936"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.transproceed.2018.08.057"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2018.04.009"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2016.02.042"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000001831"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/cld.693"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/HEP.0000000000000267"},{"issue":"4","key":"e_1_2_8_18_1","article-title":"Glucocorticosteroids for people with alcoholic hepatitis","volume":"4","author":"Pavlov CS","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.3390\/medicina60020311"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2009.04.062"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2024.01.031"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/cld.736"},{"key":"e_1_2_8_23_1","unstructured":"U.S. Health Resources & Services Administration (HRSA). 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