Post-transplant complications predict alcohol relapse in liver transplant recipients
Kitajima T, Nagai S, Segal A, Magee M, Blackburn S, Ellithorpe D, Yeddula S, Qadeer Y, Yoshida A, Moonka D, Brown K, and Abouljoud MS. Post-transplant complications predict alcohol relapse in liver transplant recipients. Liver Transpl 2019.
Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
Alcohol relapse after liver transplantation (LT) in patients with alcohol-related liver disease (ALD) is a major challenge. While its association with pre-transplant psychosocial factors was extensively studied, the impact of post-transplant courses on alcohol relapse have not been well investigated. The aim of this study is to analyze peri-transplant factors associated with post-transplant alcohol relapse in patients with ALD. This study evaluated 190 adult liver transplant patients with ALD from 2013 to 2019. Risk factors for alcohol relapse were analyzed, focusing on post-transplant chronic complications, which were classified as Clavien-Dindo classification 3a or higher that lasted over 30 days. The post-transplant alcohol relapse rate was 13.7% (26/190) with a median onset time of 18.6 months post-transplant. Multivariate Cox regression analysis revealed that post-transplant chronic complication was an independent risk factor for post-transplant 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 abstinence period <1.5years (HR 12.05, P=0.001). A risk prediction model was created using three pre-transplant risk factors (psychiatric comorbidity, alcohol relapse before LT and abstinence period <1.5years). This model clearly stratified the risk of alcohol relapse into high, mid and low-risk groups (P<0.001). Of the 26 patients who relapsed, 11 (42%) continued drinking, of whom three died of severe alcoholic hepatitis and 13 (50%) achieved sobriety. Conclusion Post-transplant chronic complications increased the risk of alcohol relapse. Recognition of post-transplant chronic complications in conjunction with the risk stratification model by pre-transplant psychosocial factors would help prediction of post-transplant alcohol relapse.
ePub ahead of print