Prior Relapse, Ongoing Alcohol Consumption, and Failure to Engage in Treatment Predict Alcohol Relapse After Liver Transplantation
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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.
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.
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.
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).
We identified important psychosocial predictors of post-LT alcohol relapse and validated SIPAT and SALT scores as pre-transplant risk factors for alcohol relapse.
KeywordsLiver cirrhosis Alcoholic Liver transplantation Alcohol relapse SIPAT score SALT score
Alcohol-related liver disease
Stanford Integrated Psychosocial Assessment for Transplant
Sustained Alcohol Use Post-Liver Transplant
Electronic health record
United Network for Organ Sharing
Center-Specific Transplant Analysis and Research
Coefficient of variation
Intensive outpatient program
Receiver operator characteristic
Model for end-stage liver disease
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.
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