Severe acute alcoholic liver disease (SAAH) unresponsive to medical therapy shows one-year-mortality rates of up to 90%. Most transplant centers request six months of alcohol abstinence prior to transplantation, the so-called “6-month rule.” This regulation is not based on strong evidence, repeatedly making it a topic of controversial debates. The majority of patients with SAAH will die before fulfilling the 6-month rule. Therefore, liver transplantation (LT) protocols are becoming more flexible towards the rigid abstinence regulation, especially concerning SAAH patients. We conducted a literature review regarding LT in SAAH and its outcomes, including post-transplant mortality and recidivism. We studied available data on PubMed from 2011 and onwards whilst including articles dealing with genetic components, medical therapy and historic snapshots of alcoholism. Emerging studies recommend LT in SAAH not responding to medical therapies even without realizing the required abstinence period, since the majority of these patients would die within 6 months. SAAH without response to medical therapy has one-year-mortality rates of up to 90%. The 6-month rule is not based on strong evidence and is repeatedly a topic of controversial debates. There is genetic linkage to alcoholism and medical therapy is not as effective as estimated, yet. The 6-months-regulation has not shown to evidently decrease the risk of recidivism post-LT, which is a lifesaving treatment in SAAH patients. Insisting on rigid sobriety rules results in excluding patients with a low risk of recidivism from being transplanted. Moreover, the genetic linkage of alcoholism must be recognized.
Alcohol Abstinence ; Alcoholics* ; Alcoholism ; Carcinoma, Hepatocellular ; Fibrosis ; Genetic Linkage ; Hepatitis, Alcoholic* ; Humans ; Liver Diseases, Alcoholic ; Liver Failure ; Liver Transplantation ; Liver* ; Mortality

Objective: To investigate the epidemiological factors associated with extra pulmonary tuberculosis (EPTB) in Kassala, Eastern Sudan. Methods: Patients infected with TB (pulmonary and extra-pulmonary) documented at the hospital were interviewed with a structured questionnaire used to gather sociodemographic information. The diagnosis of EPTB cases was based on presence of tuberculous granulomas in the histological samples, positive PCR to DNA of mycobacterium tuberculosis, radiological findings and fluid analysis suggestive of EPTB and clinical diagnosis with adequate response to anti-tuberculous therapy. Results: A total of 985 patients with TB were enrolled in the study, including 761 (77.3%) with PTB and 224 (22.7%) with EPTB. The mean age (SD) of patients with PTB and EPTB was 33.2 (15.4) and 34.7 (14.6) years respectively. The prevalence of EPTB was at (22.7%), with TB lymphadenitis 79 (35.3%), marking the frequent form of EPTB followed by peritoneal TB 27 (12.05%). While residence and occupation were not associated with EPTB, those with lower level of education (OR = 0.3; confidence intervals (CI) = 0.2-0.5; P < 0.001), female (OR = 8.7, CI = 4.9-15.1, P < 0.001), non vaccination (OR = 70.3, CI = 34.2-144.3, P < 0.001), and non smoker (OR = 0.1; CI = 0.06-0.20; P < 0.001), were associated with high prevalence of EPTB. Conclusions: Around one quarter of patients with TB in this study were more likely to have EPTB. Therefore, effective strategic plans regarding diagnostic procedures and control measures are needed to reduce the burden of the disease in Sudan.