Novel scoring tool predicts alcohol relapse after liver transplant with 96.2% sensitivity
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Key takeaways:
- The tool’s score is derived from a patient’s history of alcohol use and other psychosocial factors.
- A patient’s score and post-LT alcohol treatment were among risk factors linked to relapse within 1 year.
VANCOUVER, British Columbia — The Social Determinant Acuity Tool accurately identified patients at risk for alcohol relapse after liver transplantation for alcoholic liver disease, according to data from the ACG Annual Scientific Meeting.
“Alcohol relapse after liver transplant for alcoholic liver disease is frequent, with incidence ranging from 4% to 95% of LT recipients,” Jiten P. Kothadia, MD, a transplant hepatologist at the University of Tennessee Health Science Center, told Healio. “This leads to poor graft function, low medication adherence and decreased overall survival.”
Kothadia continued: “There is a need for developing a prognostic score that will identify patients at low risk for alcohol relapse post-LT, with the goal of improving long-term outcomes through more refined patient selection and/or provision of post-transplant interventions to minimize risk of harmful alcohol use.”
To evaluate the accuracy of the Social Determinant Acuity Tool (S-DAT), Kothadia and colleagues evaluated 140 patients who underwent LT for alcoholic liver disease from January 2016 to November 2021, all of whom were evaluated before transplantation to determine history of alcohol use and other psychosocial factors.
Researchers stratified patients according to S-DAT score, from excellent (score = 0-6) to poor (score = 35-40), for post-LT outcomes.
“S-DAT is a comprehensive score derived from patient’s cognitive function, mental health, coping ability, social support, financial insurance issues, compliance, history of alcohol abuse, history of substance abuse, problems with reliability and behavior, legal issues, understanding of the transplant process and patient’s willingness to transplant,” Kothadia said.
Result showed the alcohol relapse rate 1 year after transplant was 18.6% and the overall relapse rate was 23.6%. S-DAT score (OR = 1.65), alcohol treatment after transplant (OR = 7.11), smoking history (OR = 0.15) and marital status (OR = 60.28) were independent risk factors for relapse within 1 year.
Further analysis of S-DAT scores showed the area under the receiver operative curve for predicting relapse within 1 year was 0.77. A cutoff score of 12 or more predicted the risk for relapse with 96.2% sensitivity and 40.4% specificity, with positive and negative predictive values of 26.9% and 97.9%, respectively.
“The S-DAT score’s high sensitivity and negative predictive values make it a good screening tool for identifying patients at low risk of alcohol relapse post-LT,” Kothadia told Healio. “Our score will guide risk-based interventions post-LT to reduce post-LT relapse and improve long-term outcomes.”
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Kothadia JP, et al. Predicting low-risk for alcohol relapse within 1 year post-liver transplant for alcoholic liver disease: S-DAT score. Presented at: ACG Annual Scientific Meeting; Oct. 20-25, 2023; Vancouver, British Columbia (hybrid meeting).
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