Younger age, prior relapse among predictors of alcohol use after liver transplant in ALD
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Key takeaways:
- Younger age, prior relapse, psychiatric comorbidities and alcohol use after cirrhosis diagnosis were among risk factors for post-LT relapse in ALD.
- SALT and HALT scores had “underwhelming predictive value.”
Researchers have identified additional predictors of relapse in patients undergoing liver transplant for alcohol-related liver disease, including younger age and prior relapse, which differ from components of current prediction scores.
“Early LT has become an increasingly frequent option for patients with alcohol-related hepatitis at many LT centers,” Karen Young, MD, of the department of internal medicine at Duke University, and colleagues wrote in Gastro Hep Advances. “Transplantation in patients with ALD, however, requires weighing the risk of alcohol relapse.”
They continued, “Scoring systems including the SALT (Sustained Alcohol Use Post-Liver Transplant) and HALT (Harmful Alcohol Use Post-Liver Transplant) scores have identified multiple risk factors for relapse after transplant ... However, there are varying levels of significance found with different thresholds for these scores.”
In a retrospective chart review, Young and colleagues evaluated risk factors associated with alcohol relapse after transplantation among 67 patients (mean age, 52.9 years; 26.9% women; 89.6% white) who underwent LT for alcohol-related cirrhosis from 2018 to 2021 at Duke University Hospital. The researchers also compared the effectiveness of SALT and HALT scores in predicting relapse and assessed severity of relapse and graft dysfunction.
After a median follow-up of 43 months, 27% of patients relapsed, of whom 89% were heavy alcohol-users and 17% experienced graft dysfunction.
Using a generalized linear model, the researchers found that younger age at time of LT (OR = 0.94; 95% CI, 0.89-0.99), prior relapse (OR = 5.07; 95% CI, 1.46-17.7), significant psychiatric comorbidities (OR = 3.9; 95% CI, 1.23-12.4) and alcohol use after a diagnosis of cirrhosis (OR = 3.77; 95% CI, 1.16-12.2) were among risk factors associated with relapse.
Shorter duration of abstinence at LT listing (P = .008) and previous treatment for substance abuse (P = .047) also were associated with risk for relapse.
When the researchers applied SALT and HALT scores to this data, they determined the scores “had underwhelming predictive value in our cohort,” with an area under the curve of 0.69 (95% CI, 0.53-0.85) and 0.66 (95% CI, 0.5-0.81), respectively. This finding suggests the “need for further optimization of prediction scores,” they said.
“In our cohort, heavy alcohol use prior to transplant and legal issues did not predict relapse, which is a common component of current prediction scores,” Young and colleagues wrote. “Less than 5% of patients transplanted for ALD at our center had graft dysfunction due to relapse after LT, suggesting overall good graft outcomes, even in those that unfortunately relapsed.”
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