Alcohol consumption patterns and predictors of use following liver transplantation for alcoholic liver disease

Abstract

For patients who receive a liver transplant (LTX) for alcoholic liver disease (ALD), investigators are focusing beyond survival to determine specific alcohol use outcomes. Studies suggest the use of alcohol ranges from 8 to 22% for the first posttransplant year with cumulative rates reaching 30 to 40% by 5 years following transplantation. Yet while investigators are interested in determining specific rates of alcohol use and predictors of use, only three studies since 1990 have been prospective. In 1998, we began a prospective study of post-LTX alcohol consumption in ALD recipients using multiple repeated measures of alcohol use. After 5 years of follow-up, we found that 22% had used any alcohol by the first year and 42% had a drink by 5 years. By 5 years, 26% drank at a heavier use (binge) pattern and 20% drank in a frequent pattern. In a univariate model, predictors of alcohol use included pre-transplant length of sobriety, a diagnosis of alcohol dependence, a history of other substance use, and prior alcohol rehabilitation. Liver Transpl 12: 813-820, 2006.

Liver Transplantation for Alcohol-Related Liver Disease

“…Several larger studies evaluating rate of relapse and factors predicting relapse after liver transplantation are shown in Table 1, the relapse rate varies from 16% to 42% and harmful relapse rate varies from 10% to 18%. 11,[23][24][25][26][27][28][29][30][31][32][33] Various factors found to predictive of post-transplant alcohol relapse are shown in Table 2. Following variables have been shown to be associated with risk of post-transplant alcohol relapse: absence of structured management program pretransplant, length of pretransplant sobriety, alcohol or other substance dependence, prior alcohol rehabilitation, poor social support/lack of partner, poor psychosomatic prognosis or psychiatric comorbidity, female sex, patients' nonacceptance of having an alcohol problem before LT, continued alcohol use after liver disease diagnosis, low motivation for alcohol treatment, and presence of a first-degree relative with alcohol abuse in family.…”

“…Following variables have been shown to be associated with risk of post-transplant alcohol relapse: absence of structured management program pretransplant, length of pretransplant sobriety, alcohol or other substance dependence, prior alcohol rehabilitation, poor social support/lack of partner, poor psychosomatic prognosis or psychiatric comorbidity, female sex, patients' nonacceptance of having an alcohol problem before LT, continued alcohol use after liver disease diagnosis, low motivation for alcohol treatment, and presence of a first-degree relative with alcohol abuse in family. 11,[23][24][25][26][27][28][29][30][31][32][33] Pretransplant sobriety predicting absence of alcohol relapse after liver transplant is not a universal finding. 11,15,[23][24][25][26][27][28][29][30][31][32][33] Scoring systems also have been proposed to predict post-transplant alcohol relapse.…”

“…11,[23][24][25][26][27][28][29][30][31][32][33] Pretransplant sobriety predicting absence of alcohol relapse after liver transplant is not a universal finding. 11,15,[23][24][25][26][27][28][29][30][31][32][33] Scoring systems also have been proposed to predict post-transplant alcohol relapse. In a study of 118 patients by Rodrigue et al, 31 the authors advised a scoring system (Alcohol Relapse Risk Assessment) to predict risk of relapse.…”

“…Several larger studies evaluating rate of relapse and factors predicting relapse after liver transplantation are shown in Table 1, the relapse rate varies from 16% to 42% and harmful relapse rate varies from 10% to 18%. 11,[23][24][25][26][27][28][29][30][31][32][33] Various factors found to predictive of post-transplant alcohol relapse are shown in …”

Identification and management of alcohol dependence and withdrawal in alcoholic liver disease

“…Both disorders are important to address clinically, especially if ALD has developed. However, alcohol-dependent patients are at higher risk of continuing to drink 2 and require more intensive treatment. Although the diagnosis should be established by a mental health clinician, brief questionnaires such as the Alcohol Use Disorders Identification Test (AUDIT) ( Table 2) can be incorporated easily into a clinical assessment to establish problematic patterns of alcohol use.…”