It Is Not All About Pretransplant Factors: Posttransplant Complications Alter the Risk of Alcohol Relapse

Abstract

One of the major challenges in liver transplantation (LT) in patients with alcohol-related liver disease (ALD) is posttransplant alcohol relapse. It was reported that incidence rate ranges from 8.7% to 42%. [1][2][3][4][5][6] Alcohol relapse, especially "harmful relapse," could lead to allograft dysfunction or failure because of alcohol toxicity. 2 Many studies are investigating pretransplant factors to determine an association with posttransplant alcohol relapse (Table 1). Psychosocial factors and drinking patterns are closely associated with posttransplant relapse. [1][2][3][4][6][7][8][9] Strong social support is protective against alcohol relapse. 9 Abstinence period has been extensively investigated as well. Most transplant centers in the United States require 6 months of abstinence before accepting patients with ALD as LT candidates, which may allow them to improve their condition or identify patients who could remain abstinent after LT. 10 However, there are reports showing conflicting results suggesting that the length of abstinence was not associated with posttransplant alcohol relapse. 1,9 Hence the rationale of the "6-month rule" in patient selection for LT to predict relapse remains controversial. 1,2,8 POsTTransPlanT COMPliCaTiOns as a nOvel PreDiCTOr FOr alCOHOl relaPseThe impact of posttransplant courses on alcohol relapse has not been well investigated. Our group recently conducted a retrospective study to investigate possible effects Abbreviations: ALD, alcohol-related liver disease; CI, confidence interval; GVDH, graft-versus-host disease; HR, hazard ratio; HRAR, high-risk alcoholism relapse; LT, liver transplantation.