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Prior Relapse, Ongoing Alcohol Consumption, and Failure to Engage in Treatment Predict Alcohol Relapse After Liver Transplantation

  • Sasha Deutsch-LinkEmail author
  • Robert M. Weinrieb
  • Lauren S. Jones
  • Steven F. Solga
  • Ethan M. Weinberg
  • Marina Serper
Original Article
  • 35 Downloads

Abstract

Background

Alcohol-related liver disease (ALD) is the leading indication for liver transplantation (LT) in the USA. Alcohol relapse post-LT can negatively impact long-term outcomes, and prognostic scoring systems are available for further study.

Aims

Our study aims were to: (1) evaluate the relationship between alcohol relapse and rejection and mortality, (2) investigate risk factors for relapse, and (3) assess predictive validity of the SIPAT (Stanford Integrated Psychosocial Assessment for Transplant) and SALT (Sustained Alcohol Use Post-Liver Transplant) scores on post-LT alcohol relapse.

Methods

We conducted a retrospective chart review of 155 patients transplanted for chronic ALD at a single transplant center. Cox proportional hazard models assessed the relationship between alcohol relapse and allograft rejection and psychosocial risk factors for relapse.

Results

20% of patients met criteria for alcohol relapse. Alcohol relapse was associated with allograft rejection (HR 2.33, 95% CI 1.11–4.91, p = .03). Three variables most strongly associated with alcohol relapse: prior relapse, failure to engage in recommended alcohol treatment, and continued drinking with liver disease, which were combined into a psychosocial model. SIPAT score≥ 21 and SALT score ≥ 7 were associated with alcohol relapse (HR 6.40, 95% CI 1.36–30.18, p = .019 and HR 2.30, 95% CI 1.12–4.75, p = .024). Receiver operator characteristic analysis compared predictive ability of our psychosocial model to SIPAT (C-statistic .83 compared to .71) and SALT (C-statistic = .77 compared to .62).

Conclusion

We identified important psychosocial predictors of post-LT alcohol relapse and validated SIPAT and SALT scores as pre-transplant risk factors for alcohol relapse.

Keywords

Liver cirrhosis Alcoholic Liver transplantation Alcohol relapse SIPAT score SALT score 

Abbreviations

ALD

Alcohol-related liver disease

LT

Liver transplant

SIPAT

Stanford Integrated Psychosocial Assessment for Transplant

SALT

Sustained Alcohol Use Post-Liver Transplant

AH

Alcoholic hepatitis

EHR

Electronic health record

UNOS

United Network for Organ Sharing

STAR

Center-Specific Transplant Analysis and Research

PEth

Phosphatidylethanol

CoV

Coefficient of variation

IOP

Intensive outpatient program

ROC

Receiver operator characteristic

MELD

Model for end-stage liver disease

Notes

Funding

No funds were required nor obtained for the present study. Marina Serper is supported by the National Institute of Diabetes, Digestive and Kidney Diseases, Award #1K23DK115897-01.

Compliance with Ethical Standards

Conflict of interest

The authors have no conflicts of interest to declare concerning the present study.

Supplementary material

10620_2019_5937_MOESM1_ESM.docx (57 kb)
Supplementary material 1 (DOCX 57 kb)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Internal MedicineUniversity of Pennsylvania Health SystemPhiladelphiaUSA
  2. 2.Department of PsychiatryUniversity of Pennsylvania Health SystemPhiladelphiaUSA
  3. 3.Department of Gastroenterology and HepatologyUniversity of Pennsylvania Health SystemPhiladelphiaUSA

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