Artificial intelligence to identify harmful alcohol use after early liver transplant for alcohol-associated hepatitis

Lee, Brian P.; Roth, Nitzan; Rao, Prathik; Im, Gene Y.; Vogel, Alexander S.; Hasbun, J; Roth, Yoel; Shenoy, Akhil; Arvelakis, Antonios; Ford, Laura; Dawe, Inga; Schiano, Thomas D.; Davis, Jordan P.; Rice, John P.; Eswaran, Sheila; Weinberg, Ethan M.; Han, Hyosun; Hsu, Christine; Fix, Oren K.; Maddur, Haripriya; Ghobrial, R. Mark; Therapondos, George; Dilkina, Bistra; Terrault, Norah A.

doi:10.1111/ajt.17059

Cited by 16 publications

(17 citation statements)

References 24 publications

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“…This was surprising given that prior literature has found numerous psychosocial factors to be associated with alcohol use in the post-liver transplant population. 16 A possible explanation could be that some prior studies were based on self-reported alcohol use, and perhaps there are certain factors associated with whether a person is willing to self-report alcohol use in certain settings, but not many factors associated with actual alcohol use when an objective tool such as PEth is used to identify recent alcohol intake. 17 follow-up appointments and readmission rates.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with a positive phosphatidylethanol test during liver transplantation evaluation

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Pearl

Fatabhoy

et al. 2023

Clinical Transplantation

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BackgroundEarly identification of alcohol use is crucial for informing recommendations of appropriate follow‐up treatment pre‐liver transplant and optimizing post‐liver transplant outcomes. The purpose of the study was to investigate whether there are psychosocial factors associated with a positive PEth test.MethodsAll patients who underwent a routine pre‐surgical psychological evaluation for liver transplant listing (all etiologies, including acute liver failure, dual organ, and re‐transplantation) at a single health care system in 2020 were included in a retrospective chart review. Data extraction included results from PEth testing and information from the psychological evaluation (i.e., demographic, psychiatric symptoms, and cognitive functioning).ResultsThere were 158 patients (73.8%) who had a PEth test, of whom 21.5% had a positive result (n = 34). Younger age was associated with a positive PEth (p < .001). ALD status and type of ALD (hepatitis vs. cirrhosis) were also associated with a positive PEth test. Other demographic characteristics and psychiatric symptoms were not associated with a positive PEth result (p > .05).ConclusionYounger age was the only significant demographic variable associated with a positive PEth test. Given the difficulty of predicting who may be using alcohol, it may be useful to use PEth testing for all patients during the pre‐liver transplant evaluation and while patients are listed for liver transplant. Early identification of alcohol use through routine PEth testing will help identify patients who are using alcohol and need further treatment for alcohol use to optimize health and post‐transplant outcomes.

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Section: Discussionmentioning

confidence: 99%

Factors associated with a positive phosphatidylethanol test during liver transplantation evaluation

Segal

Pearl

Fatabhoy

et al. 2023

Clinical Transplantation

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“…Lee et al [ 152 ] developed an artificial intelligence model to predict post-LT harmful alcohol consumption in patients who underwent early liver transplant for alcohol associated hepatitis, using variables generated through content analysis: These variables included the identification of a primary support person, the presence of young children or grandchildren living with the patient, being a home caregiver for children or elderly relatives, opioid abuse, and being religious; this model could predict harmful alcohol consumption in the external validation set with a positive predictive value of 0.82 (95%CI: 0.625–1.000) and a negative predictive value of 0.81 (95%CI: 0.803–0.819), with and AUC of 0.69, indicating potential for AI to assist in the discovery of novel predictors of post-LT hazardous alcohol use, which may be used as a tool to tailor therapies for alcohol use disorder based on a projected likelihood of relapse.…”

Section: Disease Recurrencementioning

confidence: 99%

Main factors influencing long-term outcomes of liver transplantation in 2022

Fuochi¹,

Anastasio²,

Lynch³

et al. 2023

World J Hepatol

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Liver transplant (LT) outcomes have markedly improved in the recent decades, even if long-term morbidity and mortality are still considerable. Most of late deaths are independent from graft function and different comorbidities, including complications of metabolic syndrome and de novo neoplasms, seem to play a key role in determining long-term outcomes in LT recipients. This review discusses the main factors associated with late mortality and suggests possible strategies to improve long-term management and follow-up after liver transplantation. In particular, the reduction of drug toxicity, the use of tools to identify high-risk patients, and setting up a multidisciplinary team also for long-term management of LT recipients may further improve survival after liver transplantation.

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“…Several scoring systems have also been developed to better risk-stratify patients with ALD with regards to posttransplant alcohol use in addition to psychosocial assessments for transplant and traditional screening tools for AUD (Table 2) [32,52,55,56 ▪ ,68–71,72 ▪ ,73 ▪ ,74–79]. A recent retrospective case–control study found that patients who underwent early liver transplantation compared with controls declined secondary to low insight into AUD had significantly more favorable Michigan Alcoholism Prognostic Scale (MAPS), High-Risk Alcoholism Relapse (HRAR), Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT), Alcohol Relapse Risk Assessment (ARRA), and Hopkins Psychosocial Scale (HPSS) scores, but Sustained Alcohol Use Post-LT (SALT) and Alcohol Use Disorders Identification Test (AUDIT-C) scores were not predictive [72 ▪ ].…”

Section: Alcohol Use Disordermentioning

confidence: 99%

mentioning

confidence: 99%

Liver transplantation for alcohol-associated hepatitis

Durkin¹,

Bittermann

2022

Current Opinion in Organ Transplantation

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Purpose of reviewEarly liver transplantation is emerging as a treatment option for severe alcohol-associated hepatitis refractory to pharmacotherapies. This review outlines the current status of transplantation for alcoholassociated hepatitis and the treatment of alcohol use disorder after liver transplantation. Recent findingsRates of early liver transplantation for alcohol-associated hepatitis are increasing with significant heterogeneity in practices across the Unites States. Recent studies have demonstrated a substantial survival benefit in patients transplanted for alcohol-associated hepatitis with improved outcomes in early vs. late transplantation, first vs. prior hepatic decompensation, and posttransplant abstinence/delayed relapse vs. early return to alcohol use. Several prediction algorithms have been developed to ascertain patients risk of alcohol relapse and aid in candidate selection, though data on treatment of alcohol use disorders in transplant recipients remains limited. SummaryAlthough controversial, early liver transplantation for severe alcohol-associated hepatitis has shown to be a lifesaving intervention. Additional research is needed to evaluate its long-term outcomes, optimize candidate selection, and understand treatment of alcohol use disorder posttransplant.

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Artificial intelligence to identify harmful alcohol use after early liver transplant for alcohol-associated hepatitis

Cited by 16 publications

References 24 publications

Factors associated with a positive phosphatidylethanol test during liver transplantation evaluation

Factors associated with a positive phosphatidylethanol test during liver transplantation evaluation

Main factors influencing long-term outcomes of liver transplantation in 2022

Liver transplantation for alcohol-associated hepatitis

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