Definition and measurement of alcohol-associated insight in early liver transplantation for acute alcohol-associated hepatitis: A systematic review.
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:
01 07 2023
01 07 2023
Historique:
received:
03
02
2023
accepted:
27
03
2023
medline:
21
6
2023
pubmed:
6
4
2023
entrez:
5
4
2023
Statut:
ppublish
Résumé
Alcohol accounts for a large disease burden in hepatology and liver transplantation (LT) and across the globe. Clinical evaluations and decisions about LT candidacy are challenging because they rely on detailed psychosocial assessments and interpretations of psychiatric and substance use disorder data, which often must occur rapidly according to the acuity of end-stage liver disease. Such difficulties commonly occur during the process of candidate selection and liver allocation, particularly during early LT (eLT) in patients with acute alcohol-associated hepatitis (AAH). Patients with AAH commonly have very recent or active substance use, high short-term mortality, psychiatric comorbidities, and compressed evaluation and treatment timetables. LT clinicians report that patients' alcohol-associated insight (AAI) is among the most relevant psychosocial data in this population, yet no studies exist examining how LT teams define and use AAI in eLT or its effect on clinical outcomes. In April 2022, we searched Ovid MEDLINE, Elsevier Embase, EBSCOhost PsycInfo and CINAHL, and Wiley Cochrane Central Register of Controlled Trials for reports describing AAH populations who underwent eLT, which also described psychosocial evaluation parameters. The searches retrieved 1603 unique reports. After eligibility screening, 8 were included in the qualitative analysis. This systematic review reveals that AAI is a poorly defined construct that is not measured in a standardized way. Yet it is a commonly cited parameter in articles that describe the psychosocial evaluation and decision-making of patients undergoing eLT for AAH. This article also discusses the general challenges of assessing AAI during eLT for AAH, existing AAI definitions and rating scales, how AAI has been used to date in the broader hepatology and LT literature, and future areas for clinical and research progress.
Sections du résumé
BACKGROUND
Alcohol accounts for a large disease burden in hepatology and liver transplantation (LT) and across the globe. Clinical evaluations and decisions about LT candidacy are challenging because they rely on detailed psychosocial assessments and interpretations of psychiatric and substance use disorder data, which often must occur rapidly according to the acuity of end-stage liver disease. Such difficulties commonly occur during the process of candidate selection and liver allocation, particularly during early LT (eLT) in patients with acute alcohol-associated hepatitis (AAH). Patients with AAH commonly have very recent or active substance use, high short-term mortality, psychiatric comorbidities, and compressed evaluation and treatment timetables. LT clinicians report that patients' alcohol-associated insight (AAI) is among the most relevant psychosocial data in this population, yet no studies exist examining how LT teams define and use AAI in eLT or its effect on clinical outcomes. In April 2022, we searched Ovid MEDLINE, Elsevier Embase, EBSCOhost PsycInfo and CINAHL, and Wiley Cochrane Central Register of Controlled Trials for reports describing AAH populations who underwent eLT, which also described psychosocial evaluation parameters. The searches retrieved 1603 unique reports. After eligibility screening, 8 were included in the qualitative analysis. This systematic review reveals that AAI is a poorly defined construct that is not measured in a standardized way. Yet it is a commonly cited parameter in articles that describe the psychosocial evaluation and decision-making of patients undergoing eLT for AAH. This article also discusses the general challenges of assessing AAI during eLT for AAH, existing AAI definitions and rating scales, how AAI has been used to date in the broader hepatology and LT literature, and future areas for clinical and research progress.
Identifiants
pubmed: 37016758
doi: 10.1097/LVT.0000000000000144
pii: 01445473-990000000-00136
doi:
Types de publication
Systematic Review
Journal Article
Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
757-767Informations de copyright
Copyright © 2023 American Association for the Study of Liver Diseases.
Références
Rehm J, Samokhvalov AV, Shield KD. Global burden of alcoholic liver diseases. J Hepatol. 2013;59:160–168.
Seitz HK, Bataller R, Cortez-Pinto H, Gao B, Gual A, Lackner C, et al. Alcoholic liver disease. Nat Rev Dis Primers. 2018;4:16.
Lee BP, Vittinghoff E, Dodge JL, Cullaro G, Terrault NA. National trends and long-term outcomes of liver transplant for alcohol-associated liver disease in the United States. JAMA Internal Med. 2019;179:340–348.
Tapper EB, Parikh ND. Mortality due to cirrhosis and liver cancer in the United States, 1999-2016: observational study. BMJ. 2018;362:k2817.
Jinjuvadia R, Jinjuvadia C, Puangsricharoen P, Chalasani N, Crabb DW, Liangpunsakul S. Concomitant psychiatric and nonalcohol-related substance use disorders among hospitalized patients with alcoholic liver disease in the United States. Alcoholism. 2018;42:397–402.
Louvet A, Labreuche J, Artru F, Bouthors A, Rolland B, Saffers P, et al. Main drivers of outcome differ between short term and long term in severe alcoholic hepatitis: a prospective study. Hepatology. 2017;66:1464–1473.
Louvet A, Naveau S, Abdelnour M, Ramond MJ, Diaz E, Fartoux L, et al. The Lille model: a new tool for therapeutic strategy in patients with severe alcoholic hepatitis treated with steroids 2007;45:1348–1354.
Kamath PS, Karpyak VM, Davis B, Desai V, Liangpunsakul S, Sanyal A, et al. Alcohol rehabilitation within 30 days of hospital discharge is associated with reduced readmission, relapse, and death in patients with alcoholic hepatitis. Clin Gastroenterol Hepatol. 2020;18:477–485.
Cotter TG, Sandikci B, Paul S, Gampa A, Wang J, Te H, et al. Liver transplantation for alcoholic hepatitis in the US: excellent outcomes with profound temporal and geographic variation in frequency. Am J Transplant. 2020;21:1039–55.
Anderson MS, Valbuena VSM, Brown CS, Waits SA, Sonnenday CJ, Englesbe M, et al. Association of COVID-19 with new waiting list registrations and liver transplantation for alcoholic hepatitis in the United States. JAMA Netw Open. 2021;4:e2131132.
Trotter J. Liver Transplantation for Alcoholic Liver Disease: Sticking to the Rules. Transplantation. 2022;106:1308–1309.
Dumortier J, Dharancy S, Cannesson A, Lassailly G, Rolland B, Pruvot FR, et al. Recurrent alcoholic cirrhosis in severe alcoholic relapse after liver transplantation: a frequent and serious complication. Am J Gastroenterol. 2015;110:1160–1166.
Lee BP, Dodge JL, Terrault NA. Excess Mortality After Liver Transplantation in Young Women With Alcohol-Associated Liver Disease. Am J Gastroenterol. 2021;116:551–559.
Lee BP, Chen P-H, Haugen C, Hernaez R, Gurakar A, Philosophe B, et al. Three-year results of a pilot program in early liver transplantation for severe alcoholic hepatitis. Ann Surg. 2017;265:20–29.
Diagnostic and statistical manual of mental disorders (DSM-5®): American Psychiatric Publishing; 2013.
European Association for the Study of the L. EASL Clinical Practice Guidelines: Management of alcohol-related liver disease. J Hepatol. 2018;69:154–181.
Asrani SK, Trotter J, Lake J, Ahmed A, Bonagura A, Cameron A, et al. Meeting report: the Dallas consensus conference on liver transplantation for alcohol associated hepatitis. Liver Transplantation. 2020;26:127–140.
Crabb DW, Im GY, Szabo G, Mellinger JL, Lucey MR. Diagnosis and treatment of alcohol-associated liver diseases: 2019 practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2020;71:306–333.
Mathurin P, Moreno C, Samuel D, Dumortier J, Salleron J, Durand F, et al. Early liver transplantation for severe alcoholic hepatitis. N Engl J Med. 2011;365:1790–1800.
Zhu J, Chen P-Y, Frankel M, Selby RR, Fong TL. Contemporary policies regarding alcohol and marijuana use among liver transplant programs in the United States. Transplantation. 2018;102:433–439.
Marková IS, Berrios GE. The meaning of insight in clinical psychiatry. Br J Psychiatry. 1992;160:850–860.
David AS. Insight and psychosis: the next 30 years. Br J Psychiatry. 2020;217:521–523.
Raftery D, Kelly PJ, Deane FP, Baker AL, Ingram I, Goh MCW, et al. Insight in substance use disorder: a systematic review of the literature. Addict Behav. 2020;111:106549.
Goldstein RZ, Craig AD, Bechara A, Garavan H, Childress AR, Paulus MP, et al. The neurocircuitry of impaired insight in drug addiction. Trends Cogn Sci. 2009;13:372–380.
Kim KM, Kim JS, Kim GJ, Kim SS, Jung JG, Kim SM, et al. The readiness to change and insight in alcohol dependent patients. J Korean Med Sci. 2007;22:453–458.
Jung J-G, Kim J-S, Kim G-J, Oh MK, Kim SS. Brief Insight-enhancement Intervention among Patients with Alcohol Dependence. J Korean Med Sci. 2011;26:11–16.
Moeller SJ, Maloney T, Parvaz MA, Alia-Klein N, Woicik PA, Telang F, et al. Impaired insight in cocaine addiction: laboratory evidence and effects on cocaine-seeking behaviour. Brain. 2010;133:1484–1493.
Digiusto E, Treloar C. Equity of access to treatment, and barriers to treatment for illicit drug use in Australia. Addiction. 2007;102:958–969.
Yen C-F, Hsiao RC, Chen C-C, Lin HC, Yen CN, Ko CH, et al. The role of insight to alcohol use disorders in insight to schizophrenia. Compr Psychiatry. 2009;50:58–62.
Singal AK, Kwo P, Kwong A, Liangpunsakul S, Louvet A, Mandrekar P, et al. Research methodologies to address clinical unmet needs and challenges in alcohol‐associated liver disease. Hepatology. 2022;75:1026–1037.
Lee BP, Vittinghoff E, Hsu C, Han H, Therapondos G, Fix OK, et al. Predicting low risk for sustained alcohol use after early liver transplant for acute alcoholic hepatitis: the sustained alcohol use post–liver transplant score. Hepatology. 2019;69:1477–1487.
Choi G, Benhammou JN, Yum JJ, Saab EG, Patel AP, Baird AJ, et al. Barriers for liver transplant in patients with alcohol-related hepatitis. J Clin Exp Hepatol. 2022;12:13–19.
Germani G, Angrisani D, Addolorato G, Merli M, Mazzarelli C, Tarli C, et al. Liver transplantation for severe alcoholic hepatitis: A multicenter Italian study. Am J Transpl. 2022;22:1191–1200.
Hanouneh IA, Humberson A, Fiorita AL, et al. Ohio solid organ transplantation consortium (OSOTC) exception criteria for early liver transplantation (LT) in severe alcoholic hepatitis Hepatology. HOBOKEN 07030-5774, NJ USA: WILEY-BLACKWELL 111 RIVER ST; 2014.
Im GY, Kim-Schluger L, Shenoy A, Schubert E, Goel A, Friedman SL, et al. Early liver transplantation for severe alcoholic hepatitis in the United States—a single‐center experience. Am J Transpl. 2016;16:841–849.
Lee BP, Roth N, Rao P, Im GY, Vogel AS, Hasbun J, et al. Artificial intelligence to identify harmful alcohol use after early liver transplant for alcohol‐associated hepatitis. Am J Transpl. 2022;22:1834–1841.
Musto J, Stanfield D, Ley D, Lucey MR, Eickhoff J, Rice JP. Recovery and outcomes of patients denied early liver transplantation for severe alcohol‐associated hepatitis. Hepatology. 2022;75:104–114.
Sundaram V, Wu T, Klein As, Noureddin M, Kim IK, Todo T, et al. Liver transplantation for severe alcoholic hepatitis: report of a single center pilot program. Transplant Proc. 2018;50:3527–3532.
Weeks SR, Sun Z, McCaul ME, Zhu H, Anders RA, Philosophe B, et al. Liver transplantation for severe alcoholic hepatitis, updated lessons from the world’s largest series. J Am Coll Surg. 2018;226:549–557.
Roth NC, Lee BP, Hasbun J, Vogel JS, Ford L, Shenoy A, et al. Novel quality metrics of psychosocial assessment predict harmful alcohol use after early liver transplantation for alcohol-associated hepatitis: 264. Hepatology. 72(S1). October 2020.
Im GY, Vogel AS, Florman S, Nahas J, Friedman SL, Aqui S, et al. Extensive health care utilization and costs of an early liver transplantation program for alcoholic hepatitis. Liver Transpl. 2022;28:27–38.
Im G, Vaidya S, Schubert ES, Brosnan M, Schnurman KK, Krimsky A, et al. Psychosocial Profiles of Patients with Severe Alcoholic Hepatitis Considered for Early Liver Transplantation in the United States: 1160. Hepatology 58(S1):p 776A, October 2013.
Im GY, Vaidya S, Schubert ES, Kim-Schluger L, Florman S, Friedman SL, et al. Initial Single-Center Experience in the United States with Early Liver Transplantation for Severe Alcoholic Hepatitis: 1128. Hepatology 58(S1): p 760A, October 2013.
Im GY, Shenoy A, Schubert ES, Goel A, Nahas J, Kim-Schluger L, et al. Early Liver Transplantation for Severe Alcoholic Hepatitis in the United States- a 4.5 Year Single-Center Experience: 1373. Hepatology 64(S1): p 687A, October 2016.
Riggs SE, Grant PM, Perivoliotis D, Beck AT. Assessment of cognitive insight: a qualitative review. Schizophr Bull. 2012;38:338–350.
Beresford TP, Turcotte JG, Merion R, Burtch G, Blow FC, Campbell D, et al. A rational approach to liver transplantation for the alcoholic patient. Psychosomatics. 1990;31:241–254.
Mccallum S, Masterton G. Liver transplantation for alcoholic liver disease: a systematic review of psychosocial selection criteria. Alcohol Alcohol. 2006;41:358–363.
Foster PF, Fabrega F, Karademir S, Sankary HN, Mital D, Williams JW. Prediction of abstinence from ethanol in alcoholic recipients following liver transplantation. Hepatology. 1997;25:1469–1477.
Bittermann T, Mahmud N, Weinberg EM, Reddy KR. Rising trend in waitlisting for alcoholic hepatitis with more favorable outcomes than other high model for end-stage liver disease in the current era. Transplantation. 2022;106:1401–1410.
Prochaska JO, DiClemente CC. Stages and processes of self-change of smoking: toward an integrative model of change. J Consult Clin Psychol. 1983;51:390.
Miller WR, Tonigan JS. Assessing drinkers' motivation for change: the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES). American Psychological Association; 1997.
Heather N, Luce A, Peck D, Dunbar B, James I. Development of a treatment version of the Readiness to Change Questionnaire. Addiction Res. 1999;7:63–83.
Freyer J, Tonigan JS, Keller S, John U, Rumpf HJ, Hapke U. Readiness to change versus readiness to seek help for alcohol problems: the development of the Treatment Readiness Tool (TReaT). J Stud Alcohol. 2004;65:801–809.
McConnaughy EA, DiClemente CC, Prochaska JO, Velicer WF. Stages of change in psychotherapy: A follow-up report. Psychotherapy: Theory, Research, Practice. Training. 1989;26:494.
Kim J, Taggar A, Quilty LC, Selby P, Caravaggio F, Ueno F, et al. A measure of illness awareness in alcohol use disorder—Alcohol Use Awareness and Insight Scale (AAS). Drug Alcohol Depend. 2021;226:108813.
Yen C-F, Dai C-Y, Hou N-J, Hsiao RC, Yu ML. Insight into Alcohol Consumption-Related Problems and Its Correlates Among Taiwanese Alcoholic Hepatogastroenterological Clinic Patients. Subst Use Misuse. 2009;44:593–594.
Pillai B, Jayaraman S. A study to assess the insight and motivation towards quitting alcohol among patients with gastrointestinal and hepatological conditions. Indian J Cont Nursing Edu. 2019;20:141.
Shen NT, Kaplan A, Fahoum K, Basu E, Shenoy A, Wahid N, et al. Identification of Quantifiable Predictors of Relapse in Patients with Alcohol‐Associated Liver Disease. Hepatol Commun. 2021;5:1156–1164.
Lambert L, Serre F, Thirioux B, Jaafari N, Auriacombe M. Clinical insight level predicts successful quit or control attempts during the first three months of outpatient addiction treatment. Drug Alcohol Depend. 2022;234:109391.
Dandaba M, Serra W, Harika-Germaneau G, Silvain C, Langbour N, Solinas M, et al. Predicting relapse in patients with severe alcohol use disorder: The role of alcohol insight and implicit alcohol associations. Addict Behav. 2020;107:106433.
Kim JS, Park BK, Kim GJ, Kim SS, Jung JG, Oh MK, et al. The role of alcoholics' insight in abstinence from alcohol in male Korean alcohol dependents. J Korean Med Sci. 2007;22:132–137.
Kim JS, Kim GJ, Lee JM, Lee CS, Oh JK. HAIS (Hanil Alcohol Insight Scale): validation of an insight-evaluation instrument for practical use in alcoholism. J Stud Alcohol. 1998;59:52–55.
Lucey MR, Carr K, Beresford TP, Fisher LR, Shieck V, Brown KA, et al. Alcohol use after liver transplantation in alcoholics: a clinical cohort follow‐up study. Hepatology. 1997;25:1223–1227.
Beresford TP, Lucey MR. Towards standardizing the alcoholism evaluation of potential liver transplant recipients. Alcohol Alcohol. 2017;53:135–144.
Webzell I, Ball D, Bell J, Sherwood RA, Marsh A, O'Grady JG, et al. Substance use by liver transplant candidates: an anonymous urinalysis study. Liver Transpl. 2011;17:1200–1204.
Park JW, Kim HS. The effects of group counseling utilizing narrative therapy on self-esteem, stress response, and insight for individuals with alcohol dependency. J Creat Ment Health. 2021:1–30.
Im SB, Yoo EH, Kim JS, Kim GJ. Adapting a cognitive behavioral program in treating alcohol dependence in South Korea. Perspect Psychiatr Care. 2007;43:183–192.
Winder GS, Clifton EG, Fernandez AC, Mellinger JL. Interprofessional teamwork is the foundation of effective psychosocial work in organ transplantation. Gen Hosp Psychiatry. 2021;69:76–80.
Donnadieu-Rigole H, Olive L, Nalpas B, Winter A, Ursic-Bedoya J, Faure S, et al. Follow-up of alcohol consumption after liver transplantation: interest of an addiction team? Alcohol Clin Exp Res. 2017;41:165–170.
Appelbaum PS. Assessment of patients' competence to consent to treatment. N Engl J Med. 2007;357:1834–1840.
Mellinger JL, Fernandez A, Shedden K, Winder GS, Fontana RJ, Volk ML, et al. Gender disparities in alcohol use disorder treatment among privately insured patients with alcohol‐associated cirrhosis. Alcoholism. 2019;43:334–341.
Rogal S, Youk A, Zhang H, Gellad WF, Fine MJ, Good CB, et al. Impact of alcohol use disorder treatment on clinical outcomes among patients with cirrhosis. Hepatology. 2020;71:2080–2092.
DiMartini A, Dew MA, Day N, Fitzgerald MG, Jones BL, DeVera ME, et al. Trajectories of alcohol consumption following liver transplantation. Am J Transpl. 2010;10:2305–2312.