A Simple Score for Predicting Alcohol Relapse After Liver Transplantation

Abstract

Background: Alcohol relapse can negatively influence the outcome after liver transplantation (LT). The aim of our study was to identify factors that could be associated with the recurrence of harmful alcohol consumption after LT. Methods: A total of 387 consecutive patients (23.8% women) who underwent LT for alcoholic cirrhosis in Geneva, Switzerland, and Lyon, France, between 1989 and 2005 were evaluated. Mean ± SD age was 51.3±7.5 years. Follow-up time was 61.2 ± 47.5 months. Alcohol consumption relapse and potential factors associated with it were studied. Results: The relapse rate of harmful alcohol consumption after LT was 11.9%. In univariate analysis, alcohol relapse was significantly associated with age greater than 50 years (P=.04), year of LT 1995 or earlier (PϽ.05), duration of abstinence less than 6 months (P= .02), presence of psychiatric comorbidities (PϽ.001), presence of a life partner (PϽ.05), and a high score on the High-Risk Alcoholism Relapse (HRAR) scale (PϽ.001). Mul-tivariate logistic regression disclosed the following independent factors of relapse: duration of abstinence of less than 6 months (odds ratio [OR], 3.3; 95% confidence interval [CI], 1.2-9.3) (P =.02); presence of psychiatric comorbidities (OR, 7.8; 95% CI, 3.1-20.0) (PϽ.001); and HRAR score higher than 3 (OR, 10.7; 95% CI, 3.8-30.0) (P=.001). In patients with none of these factors, alcohol relapse was 5%, while the presence of 1, 2, or 3 factors was associated with relapse rates of 18%, 64%, and 100% of the patients, respectively. Conclusions: In a large cohort of patients undergoing LT for alcoholic cirrhosis, a duration of abstinence of less than 6 months before wait-listing for LT, the presence of psychiatric comorbidities, or an HRAR score higher than 3 was associated with relapse into harmful drinking. The presence of more than 1 factor dramatically increased this risk over 50%. In the pre-LT evaluation in this setting, these factors should be accurately determined.

Liver Transplantation for Alcohol-Related Liver Disease

“…Several larger studies evaluating rate of relapse and factors predicting relapse after liver transplantation are shown in Table 1, the relapse rate varies from 16% to 42% and harmful relapse rate varies from 10% to 18%. 11,[23][24][25][26][27][28][29][30][31][32][33] Various factors found to predictive of post-transplant alcohol relapse are shown in Table 2. Following variables have been shown to be associated with risk of post-transplant alcohol relapse: absence of structured management program pretransplant, length of pretransplant sobriety, alcohol or other substance dependence, prior alcohol rehabilitation, poor social support/lack of partner, poor psychosomatic prognosis or psychiatric comorbidity, female sex, patients' nonacceptance of having an alcohol problem before LT, continued alcohol use after liver disease diagnosis, low motivation for alcohol treatment, and presence of a first-degree relative with alcohol abuse in family.…”

“…Following variables have been shown to be associated with risk of post-transplant alcohol relapse: absence of structured management program pretransplant, length of pretransplant sobriety, alcohol or other substance dependence, prior alcohol rehabilitation, poor social support/lack of partner, poor psychosomatic prognosis or psychiatric comorbidity, female sex, patients' nonacceptance of having an alcohol problem before LT, continued alcohol use after liver disease diagnosis, low motivation for alcohol treatment, and presence of a first-degree relative with alcohol abuse in family. 11,[23][24][25][26][27][28][29][30][31][32][33] Pretransplant sobriety predicting absence of alcohol relapse after liver transplant is not a universal finding. 11,15,[23][24][25][26][27][28][29][30][31][32][33] Scoring systems also have been proposed to predict post-transplant alcohol relapse.…”

“…11,[23][24][25][26][27][28][29][30][31][32][33] Pretransplant sobriety predicting absence of alcohol relapse after liver transplant is not a universal finding. 11,15,[23][24][25][26][27][28][29][30][31][32][33] Scoring systems also have been proposed to predict post-transplant alcohol relapse. In a study of 118 patients by Rodrigue et al, 31 the authors advised a scoring system (Alcohol Relapse Risk Assessment) to predict risk of relapse.…”

“…Patients in groups ARRA III (score 4-6) and ARRA IV (score 7-9) had significantly higher rates of alcohol relapse and were more likely to return to pretransplant levels of drinking. Another score found to be useful to predict post-transplant alcohol relapse is High Risk Alcoholism Relapse (HRAR) score; 26 it consists of the following three variables: duration of heavy drinking, number of daily drinks, and number of prior alcoholism inpatient treatment experiences. Each item is scored as 0-2 and total possible score ranges from 0 to 6.…”

“…Several larger studies evaluating rate of relapse and factors predicting relapse after liver transplantation are shown in Table 1, the relapse rate varies from 16% to 42% and harmful relapse rate varies from 10% to 18%. 11,[23][24][25][26][27][28][29][30][31][32][33] Various factors found to predictive of post-transplant alcohol relapse are shown in …”