Prediction of Alcohol Relapse Among Liver Transplant Candidates With Less Than 6 Months of Abstinence Using the High-Risk Alcoholism Relapse Score.
Age Factors
Alcohol Abstinence
/ psychology
Alcoholism
/ complications
Allografts
/ pathology
Chronic Disease
/ psychology
Female
Follow-Up Studies
Hepatitis, Alcoholic
/ diagnosis
Humans
Liver
/ pathology
Liver Cirrhosis, Alcoholic
/ epidemiology
Liver Transplantation
/ standards
Male
Middle Aged
Postoperative Complications
/ epidemiology
Prognosis
Recurrence
Retrospective Studies
Risk Assessment
Risk Factors
Severity of Illness Index
Sex Factors
Time Factors
Journal
Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
ISSN: 1527-6473
Titre abrégé: Liver Transpl
Pays: United States
ID NLM: 100909185
Informations de publication
Date de publication:
08 2019
08 2019
Historique:
received:
09
08
2018
accepted:
16
03
2019
pubmed:
29
3
2019
medline:
18
8
2020
entrez:
29
3
2019
Statut:
ppublish
Résumé
The selection of liver transplantation (LT) candidates with alcohol-use disorder (AUD) is influenced by the risk of alcohol relapse (AR) after LT. We aimed to investigate the risk factors of AR after LT and its impact on graft and recipient outcomes. A retrospective study was conducted that included all consecutive patients with AUD undergoing LT from January 2004 to April 2016 (n = 309), excluding patients with alcoholic hepatitis. Odds ratios (ORs) and 95% confidence intervals (CIs) for AR were analyzed by multinomial logistic regression. Cox regression with time-dependent covariates was used to analyze patient survival and graft cirrhosis. There were 70 (23%) patients who presented AR (median follow-up, 68 months), most of them (n = 44, 63%) presenting heavy AR. The probability of heavy AR was 2.3%, 7.5%, 12%, and 29% at 1, 3, 5, and 10 years after LT, respectively. The independent risk factors for heavy AR included a High-Risk Alcoholism Relapse (HRAR) score ≥3 (OR, 2.39; 95% CI, 1.02-5.56; P = 0.04) and the duration of abstinence (months) before LT (OR, 0.81; 95% CI, 0.66-0.98; P = 0.03). In recipients with <6 months of abstinence before LT, the probability of heavy AR after LT was higher in patients with an HRAR score ≥3 than in those with an HRAR score <3 (20%, 36.7%, and 47% versus 6.8%, 12.4%, and 27% at 1, 3, and 5 years, respectively; log-rank 0.013). The risk of graft cirrhosis was increased in patients with heavy AR (hazard ratio, 3.44; 95% CI, 1.58-7.57; P = 0.002) compared with nonrelapsers, with no differences in patient survival. In conclusion, the HRAR score is helpful in identifying the risk of harmful AR after LT in candidates with <6 months of alcohol abstinence without alcoholic hepatitis. These patients could benefit from a longterm integrative patient-centered approach after LT until lifestyle changes are implemented.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1142-1154Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2019 by the American Association for the Study of Liver Diseases.