Trajectories of Alcohol Consumption Following Liver Transplantation

Abstract

Any use of alcohol in the years following liver transplantation (LTX) approaches 50% of patients transplanted for alcoholic liver disease (ALD).We collected detailed prospective data on alcohol consumption following LTX for ALD to investigate ongoing patterns of use. Using trajectory modeling we identified four distinct alcohol use trajectories. One group had minimal use over time. Two other groups developed early onset moderate-to-heavy consumption and one group developed late onset moderate use. These trajectories demonstrate that alcohol use varies based on timing of onset, quantity and duration. Using discriminant function analysis, we examine characteristics of recipient's pre-LTX alcohol histories and early post-LTX psychological stressors to identify the profile of those at risk for these specific trajectories. We discuss the relevance of these findings to clinical care and preliminarily to outcomes.

Perceptions of post-transplant recidivism in liver transplantation for alcoholic liver disease

“…The rates of alcoholic recidivism ranged widely from 10% to 42% as a result of inconsistent definitions on alcoholic recidivism and follow-up time. In fact, DiMartini et al [33] classified post-transplant alcohol consumption patterns into five categories based on time until relapse, three of which are harmful to the patients: no alcohol use, infrequent/low level of consumption, early onset/ moderate and decreased consumption, later onset/harmful level of consumption, and early onset/heavy/increasing consumption. According to this classification, 46% of patients developed alcohol recidivism, with harmful use of alcohol accounting for 19%.…”

Immunophyllin Ligands Show Differential Effects on Alcohol Self-Administration in C57BL Mice

“…A series of reports over the past 20 years from different clinical centers (Lucey, 2007;DiMartini et al, 2010) document remarkably high abstinence rates among alcohol-dependent (AD) liver graft recipients. In most centers complete abstinence occurs in approximately 90% of cases at 1 year after the transplant and in the 75 to 80% range after 3 years.…”

The Role of Liver Transplantation in theTreatment of Alcoholic Liver Disease

“…In addition to the studies supporting that the length of sobriety is a strong predictor of recidivism, there are others reporting that patients with a DSM-IV diagnosis of abuse had a lower relapse probability than those with alcohol dependence (DiMartini et al, 2006;Karim et al, 2010). DiMartini et al showed that variables such as alcohol dependence, short length of sobriety, family history of alcohol consumption and the use of other substances identified patients with a major risk of relapse (DiMartini et al, 2010). Despite that there are studies showing that pre-LT behavior is a poor predictor of relapse, or that other variables such as demographic, family and social ones come into play (De Gottardi et al, 2007;Foster et al, 1997;Kelly et al, 2006;Pfitzmann et al, 2007).…”

“…By 5 years, 26% drank at a heavier use pattern and 20% in a frequent pattern. In another prospective study by DiMartini et al, there were five different patterns of alcohol consumption identified, based on the time of relapse and the subsequent pattern (DiMartini et al, 2010). Approximately 80% of the patients either did not drink or consumed only small amounts rarely.…”

“…These observations, together with those by DiMartini documenting the five patterns of alcohol use, need validation in a large prospective cohort, and if successful can help clinicians identify tailored monitoring and interventions. Behavioral and pharmacological therapies may be necessary and helpful, but it is essential that they are individualized and that the support required is discussed and agreed upon with the candidate and their support system (DiMartini et al, 2010).…”