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

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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.

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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

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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.

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Author notes

  1. Ethan M. Weinberg and Marina Serper: share senior authorship.

Authors and Affiliations

  1. Department of Internal Medicine, University of Pennsylvania Health System, Philadelphia, PA, USA

    Sasha Deutsch-Link

  2. Department of Psychiatry, University of Pennsylvania Health System, Philadelphia, PA, USA

    Robert M. Weinrieb

  3. Department of Gastroenterology and Hepatology, University of Pennsylvania Health System, Philadelphia, PA, USA

    Lauren S. Jones, Steven F. Solga, Ethan M. Weinberg & Marina Serper

Authors
  1. Robert M. Weinrieb
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  2. Lauren S. Jones
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  3. Steven F. Solga
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  4. Ethan M. Weinberg
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Correspondence to Sasha Deutsch-Link.

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Deutsch-Link, S., Weinrieb, R.M., Jones, L.S. et al. Prior Relapse, Ongoing Alcohol Consumption, and Failure to Engage in Treatment Predict Alcohol Relapse After Liver Transplantation. Dig Dis Sci 65, 2089–2103 (2020). https://doi.org/10.1007/s10620-019-05937-4

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  • DOI: https://doi.org/10.1007/s10620-019-05937-4

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