Early liver transplantation (LT) for severe alcoholic hepatitis (AH) is a rescue therapy for highly selected patients with favorable psychosocial profiles not responding to medical therapy. Given the expected increase of AH candidate referrals requiring complex care and comprehensive evaluations, increased workload and cost might be expected from implementing an early LT program for AH but have not been determined. Some centers may also view AH as a strategy to expeditiously increase LT volume and economic viability. The aim of this study was to determine the health care use and costs of an early LT program for AH. Analyses of prospective databases of AH, interhospital transfers, and the hospital accounting system at a single center were performed from July 2011 to July 2016. For 5 years, 193 patients with severe AH were evaluated at our center: 143 newly referred transfers and 50 direct admissions. Annual increases of 13% led to 2 to 3 AH transfers/month and AH becoming the top reason for transfer. There were 169 (88%) nonresponders who underwent psychosocial evaluations; 15 (9%) underwent early LT. The median cost of early LT was $297,422, which was highly correlated with length of stay (r = 0.83; P < 0.001). Total net revenue of the program from LT admission to 90 days after LT was −$630,305 (−5.0% revenue), which was inversely correlated with MELD score (r = −0.70; P = 0.004) and yielded lower revenue than a contemporaneous LT program for acute-on-chronic liver failure (ACLF; $118,168; 1.4% revenue; P = 0.001). The health care use and costs of an early LT program for AH are extensive and lifesaving with marginally negative net revenue. Significantly increasing care of severe AH patients over 5 years resulted in increased LT volume, but at a lower rate than ACLF, and without improving economic outcomes due to high MELD and prolonged length of stay.

中文翻译：

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酒精性肝炎早期肝移植计划的广泛医疗保健利用和成本

针对严重酒精性肝炎 (AH) 的早期肝移植 (LT) 是一种针对具有良好社会心理特征且对药物治疗无反应的经过精心挑选的患者的挽救疗法。鉴于需要复杂护理和综合评估的 AH 候选人转介的预期增加，实施 AH 的早期 LT 计划可能会增加工作量和成本，但尚未确定。一些中心也可能将 AH 视为一种快速增加 LT 数量和经济可行性的策略。本研究的目的是确定 AH 早期 LT 计划的医疗保健用途和成本。2011 年 7 月至 2016 年 7 月，对单个中心的 AH 前瞻性数据库、院间转运和医院会计系统进行了分析。5 年来，我们中心对 193 名重度 AH 患者进行了评估：新转介143人，直接录取50人。每年 13% 的增长导致每月 2 到 3 次 AH 转账，AH 成为转账的首要原因。有 169 名 (88%) 无反应者接受了社会心理评估；15 人 (9%) 接受了早期 LT。早期 LT 的中位成本为 297,422 美元，与住院时间高度相关（r  = 0.83；P  < 0.001）。该项目从 LT 入院到 LT 后 90 天的总净收入为 −630,305 美元（−5.0% 收入），与 MELD 评分呈负相关（r  = −0.70；P  = 0.004），并且产生的收入低于同时期的 LT 项目对于慢加急性肝衰竭（ACLF；118,168 美元；1.4% 的收入；P  = 0.001）。AH 的早期 LT 计划的医疗保健使用和成本是广泛的和挽救生命的，净收入略微为负。显着增加严重 AH 患者超过 5 年的护理导致 LT 量增加，但速度低于 ACLF，并且由于高 MELD 和延长住院时间而没有改善经济结果。