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by Multiple Authorship | November 14th, 2018

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Early Transplant in Alcoholic Hepatitis Feasible

  • by Michael Smith, North American Correspondent, MedPage Today October 23, 2017
  • WASHINGTON -- Selected patients with a failing liver owing to alcoholic hepatitis, but who have not been abstinent for several months, can still have "acceptable" short-term survival after transplant, a researcher said here.

In a retrospective analysis of patients in 12 transplant centers, 1-year survival was 94% over a median follow-up of 1.6 years, according to Brian Lee, MD, of the University of California San Francisco.

But the survival rate fell to 84% after 3 years, largely owing to continued alcohol use after the transplant, Lee said at the Liver Meeting, the annual conference of the American Association for the Study of Liver Diseases (AASLD).

"Sustained alcohol was the strongest predictor of post-transplant death," Lee said.

There are no effective therapies for long-term survival in severe alcoholic hepatitis, which has about a 70% mortality rate after 6 months, Lee noted. A transplant can be life saving, he added.

But most U.S. centers won't perform a transplant unless the patient has been abstinent for at least 6 months, although there is recent research suggesting that an early procedure -- ignoring the 6-month rule -- can be beneficial in selected patients.




Concierge Medicine:  6-11-2017

The day after my friend sent me a link to this NY Times article: https://www.nytimes.com/2017/06/03/business/economy/high-end-medical-care.html , I met a real life concierge internist at a meeting. Full disclosure, I told him that I ran a website FindADoc.Com and that concierge physicians looking to attract patients could do worse that become Featured Docs on FindADoc. He has a patient base of 200 souls and charges $3000 a year, which I quickly translated to $600k a year. He has minimal overheads. No nurses, NP or PA. Patients have direct access to his cell phone 24/7. When I told him about this article, and the fact that the charge is up to $80,000 a patient or family, I could feel his jaw drop as he made the quick calculation!

In truth, this really is nothing new. At a well-known hospital in the Upper East Side, NY, much larger sums of money change hands, just not quite like that, or so openly. For $700m, you can build a new Pavillion with your name on it. Or for $300 million, change the name of the hospital and medical school to yours! That way, when you call up with an ingrowing toe-nail, guess how long you mind have to wait to have it fixed!!



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