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Utility of scores to predict alcohol use after liver transplant (lt): take them with a grain of salt.

Utility of scores to predict alcohol use after liver transplant (lt): take them with a grain of salt. Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society Houston, K., Duong, N., Sterling, R. K., Asgharpour, A., Bullock, S., Weinland, S., Keller, N., Smirnova, E., Khan, H., Matherly, S., Wedd, J., Lee, H., Siddiqui, M., Patel, V., Arias, A., Kumaran, V., Lee, S., Sharma, A., Khan, A., Imai, D., Levy, M., Bruno, D. 2024

Abstract

The Sustained Alcohol use post-Liver Transplant (SALT) and the High-Risk Alcohol Relapse (HRAR) scores were developed to predict return to alcohol use after liver transplant (LT) for alcohol associated liver disease (ALD).A retrospective analysis of deceased donor LT 10/2018 to 4/2022 was performed. All patients (pts) underwent careful pre-LT psychosocial evaluation. Data on alcohol use, substance abuse, prior rehabilitation, and legal issues were collected. Post-LT, all were encouraged to participate in rehabilitation programs and underwent interval phosphatidylethanol (PeTH) testing. Pts with ALD were stratified by < or > 6 month sobriety prior to listing. Those with <6 month were further stratified as acute alcoholic hepatitis (AH) by NIAAA criteria and non-AH. The primary outcome was utility of the SALT (<5 vs. =5) and HRAR (<3 vs. =3) scores to predict return to alcohol use (+PeTH) within 1 year after LT.Of the 365 LT, 86 had > 6 month sobriety and 85 had <6 month sobriety; 41 with AH and 44 non-AH. In those with AH, the mean time of abstinence to LT was 58 days, and 71% failed prior rehabilitation. Following LT, return to drinking was similar in the AH (24%) compared to <6M non-AH (15%) and >6M ALD (22%). Only 4% had returned to heavy drinking. The accuracy of both the SALT and HRAR scores to predict return to alcohol was low (accuracy 61-63%) with poor sensitivity (46% and 37%), specificity (67-68%), positive predictive value (22-26%) with moderate negative predictive value (NPV) (81-83%), respectively with higher NPVs (95%) in predicting return to heavy drinking.Both SALT and HRAR scores had good NPV in identifying patients at low risk for recidivism.

View details for DOI 10.1097/LVT.0000000000000407

View details for PubMedID 38775570