The multidisciplinary support in preventing alcohol relapse after liver transplantation: A single‐center experience

Attilia, Maria Luisa; Lattanzi, Barbara; Ledda, Roberta Eufrasia; Gallì, Anna; Farcomeni, Alessio; Rotondo, Claudia; Gregorio, V. Di; Mennini, Gianluca; Poli, Edoardo; Attilia, Fabio; Corradini, Stefano Ginanni; Rossi, Massimo; Merli, Manuela

doi:10.1111/ctr.13243

Cited by 26 publications

(27 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Search procedures (Figure ) yielded 471 unique abstracts (1986‐2018), 75 full‐text articles screened, and 11 eligible reports from 10 unique research teams. Reports included 2 completed and 1 failed randomized trial, and 8 observational studies (3 prospective and 5 retrospective) . Refer to Table for study characteristics.…”

Section: Resultsmentioning

confidence: 99%

A review of behavioral alcohol interventions for transplant candidates and recipients with alcohol-related liver disease

Schlagintweit

Lynch

Hendershot

2019

American Journal of Transplantation

View full text Add to dashboard Cite

Alcohol‐related liver disease (ALD) is a common indication for liver transplantation. Reflecting growing consensus that early transplant (ie, prior to sustained abstinence) can be a viable option for acute alcoholic hepatitis, access to liver transplantation for ALD patients has increased. Prevention of alcohol relapse is critical to pretransplant stabilization and posttransplant survival. Behavioral interventions are a fundamental component of alcohol use disorder treatment, but have rarely been studied in the transplant context. This scoping review summarizes published reports of behavioral and psychosocial alcohol interventions conducted with ALD patients who were liver transplant candidates and/or recipients. A structured review identified 11 eligible reports (3 original research studies, 8 descriptive papers). Intervention characteristics and clinical outcomes were summarized. Interventions varied significantly in orientation, content, delivery format, and timing/duration. Observational findings illustrate the importance of situating alcohol interventions within a multidisciplinary treatment context, and suggest the potential efficacy of cognitive‐behavioral and motivational enhancement interventions. However, given extremely limited research evaluating behavioral alcohol interventions among ALD patients, the efficacy of behavioral interventions for pre‐ and posttransplant alcohol relapse remains to be established.

show abstract

Section: Resultsmentioning

confidence: 99%

A review of behavioral alcohol interventions for transplant candidates and recipients with alcohol-related liver disease

Schlagintweit

Lynch

Hendershot

2019

American Journal of Transplantation

View full text Add to dashboard Cite

show abstract

“…It is crucial to initiate earlier interventions to decrease the risk of alcohol relapse. (7) Further studies are warranted to validate the utility of our risk stratification model in conjunction with recognition of posttransplant chronic complications.…”

Section: Discussionmentioning

confidence: 99%

“…These findings suggest that patients in the high‐risk group may require close posttransplant follow‐up regardless of their chronic complication status, whereas those in the moderate‐ and low‐risk groups should also be carefully monitored with medical and social support from a multidisciplinary team, especially if they develop chronic complications after LT. It is crucial to initiate earlier interventions to decrease the risk of alcohol relapse . Further studies are warranted to validate the utility of our risk stratification model in conjunction with recognition of posttransplant chronic complications.…”

Section: Discussionmentioning

confidence: 99%

“…Alcohol‐related liver disease (ALD) is currently the leading indication for liver transplantation (LT) in the United States, and the number of transplant patients with ALD has rapidly increased . Major challenges in LT in patients with ALD include alcohol relapse after LT, which ranges from 8.7% to 42% . Alcohol relapse, especially harmful relapse, could lead to allograft dysfunction or failure due to alcohol toxicity …”

mentioning

confidence: 99%

“…(1,2) Major challenges in LT in patients with ALD include alcohol relapse after LT, which ranges from 8.7% to 42%. (3)(4)(5)(6)(7)(8) Alcohol relapse, especially harmful relapse, could lead to allograft dysfunction or failure due to alcohol toxicity. (4) Pretransplant predictors for alcohol relapse have been extensively investigated.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Posttransplant Complications Predict Alcohol Relapse in Liver Transplant Recipients

Kitajima¹,

Nagai²,

Segal³

et al. 2020

Liver Transpl

View full text Add to dashboard Cite

Alcohol relapse after liver transplantation (LT) in patients with alcohol‐related liver disease (ALD) is a major challenge. Although its association with pretransplant psychosocial factors was extensively studied, the impacts of posttransplant courses on alcohol relapse have not been well investigated. The aim of this study is to analyze peritransplant factors associated with posttransplant alcohol relapse in patients with ALD. This study evaluated 190 adult LT patients with ALD from 2013 to 2019. Risk factors for alcohol relapse were analyzed, focusing on posttransplant chronic complications, which were classified as Clavien‐Dindo classification 3a or higher that lasted over 30 days. The posttransplant alcohol relapse rate was 13.7% (26/190) with a median onset time of 18.6 months after transplant. Multivariate Cox regression analysis revealed that posttransplant chronic complications were an independent risk factor for posttransplant alcohol relapse (hazard ratio [HR], 5.40; P = 0.001), along with psychiatric comorbidity (HR, 3.93; P = 0.001), history of alcohol relapse before LT (HR, 3.00; P = 0.008), and an abstinence period <1.5 years (HR, 12.05; P = 0.001). A risk prediction model was created using 3 pretransplant risk factors (psychiatric comorbidity, alcohol relapse before LT, and abstinence period <1.5 years). This model clearly stratified the risk of alcohol relapse into high‐, moderate‐, and low‐risk groups (P < 0.001). Of the 26 patients who relapsed, 11 (42.3%) continued drinking, of whom 3 died of severe alcoholic hepatitis, and 13 (50.0%) achieved sobriety (outcomes for 2 patients were unknown). In conclusion, posttransplant chronic complications increased the risk of alcohol relapse. Recognition of posttransplant chronic complications in conjunction with the risk stratification model by pretransplant psychosocial factors would help with the prediction of posttransplant alcohol relapse.

show abstract

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

Kitajima

Nagai

Moonka

et al. 2020

Clinical Liver Disease

View full text Add to dashboard Cite

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.

show abstract

The multidisciplinary support in preventing alcohol relapse after liver transplantation: A single‐center experience

Abstract: This study shows that a MS program may contribute to alcohol relapse prevention after LT in ALD patients. However, the relevance of this support needs to be confirmed by clinical trials.

Cited by 26 publications

References 35 publications

A review of behavioral alcohol interventions for transplant candidates and recipients with alcohol-related liver disease

A review of behavioral alcohol interventions for transplant candidates and recipients with alcohol-related liver disease

Posttransplant Complications Predict Alcohol Relapse in Liver Transplant Recipients

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

Contact Info

Product

Resources

About