The High-Risk Alcoholism Relapse Score Predicts Alcohol Relapse Among Liver Transplant Candidates with Less Than Six Months of Abstinence.

BACKGROUND & AIMS: The selection of liver transplant (LT) candidates with alcohol use disorder 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.

METHODS: Retrospective study including all consecutive patients with alcohol use disorder undergoing LT from January 2004 to April 2016 (n=309), excluding alcoholic hepatitis. Odds ratios (OR; 95%CI) for AR were analyzed by multinomial logistic regression. Cox regression with time-dependent covariates was used to analyze patient survival and graft cirrhosis.

RESULTS: Seventy (23%) patients 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 score (HRAR) ≥ 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 less than 6 months of abstinence before LT, the probability of heavy AR after LT was higher in patients with HRAR ≥ 3 than in those with HRAR < 3 (20%, 36.7% and 47% vs 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 (HR=3.44; 95% CI (1.58-7.57); p=0.002) compared to non-relapsers with no differences in patient survival.

CONCLUSIONS: The HRAR score is helpful to identify the risk of harmful AR after LT in candidates with less than 6 months of alcohol abstinence without alcoholic hepatitis. These patients could benefit from a long-term integrative patient-centered approach after LT until lifestyle changes are consolidated. This article is protected by copyright. All rights reserved.