ST3 Gastroenterology Interview
Should liver transplants be offered to patients with acute alcoholic hepatitis?
• Understand acute alcoholic hepatitis is liver failure occurring rapidly (within 6 weeks) secondary to alcohol. It can often lead to multi organ failure and death. At that stage the only current option for survival is a liver transplant. This is currently not offered in the UK because there has been no recidivism (by definition) from alcohol.
• Self inflicted but have not had the opportunity to change lifestyle. Understand there is an argument that paracetamol overdose, which is transplantable is more ‘self inflicted’
• Broader topic of transplanting patients with liver failure to alcohol
• Survival of alcoholic patients post transplant is in line with patients transplanted for other causes
• Understand alcoholism is a medical condition in its own right often secondary to psychiatric and environmental problems
• Resource argument in taking a potential life saving treatment from someone else
• Understand the new national strategy from the RCP for dealing with alcoholic liver disease including a ban on advertising and a minimum price policy
Investigation portfolio contemporary
• The standard investigations should be presented including basic biochemical screen including renal and liver function; thyroid function; Vitamin B 12 levels; brain imaging.
• This includes when additional investigations may be needed of specific nature with indication.
• Understands were additional assessment is needed such as neuropsychological tests
Pitfalls to Avoid
• Don’t be too dogmatic, better to say there is a role for guidelines but some cases need to be addressed on individual merit and after consulting widely with colleagues or discussion with the local transplant centre.