Alcohol and Alcoholism Advance Access originally published online on February 13, 2006
Alcohol and Alcoholism 2006 41(3):278-283; doi:10.1093/alcalc/agh257
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PREDICTORS OF RELAPSE TO HARMFUL ALCOHOL AFTER ORTHOTOPIC LIVER TRANSPLANTATION
1 Alcohol Problems Service and 2 Consultant Psychiatrist, Alcohol Problems Service, Royal Edinburgh Hospital, Scotland, 3 Drug Health Services, 4 Consultant Liaison Psychiatry and 5 Australian National Liver Transplant Unit, AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, Australia and 6 Associate Professor in Biostatistics, University of the Sunshine Coast and Honorary Research Associate and 7 Discipline of Medicine, University of Sydney, Australia
* Author to whom correspondence should be addressed at: Drug Health Services, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia. Tel.: +61 2 9515 6419; Fax: +61 2 9515 8970; E-mail: phaber{at}mail.usyd.edu.au
(Received 16 September 2005; first review notified 12 November 2005; in revised form 28 November 2005; accepted 29 November 2005)
Background: End-stage alcoholic liver disease (ALD) is a common indication for liver transplantation. Outcomes may be limited by return to harmful drinking. Previous studies have identified few predictors of drinking relapse. Aim: This study examined novel postulated predictors of relapse to drinking. Method: The case notes of all patients transplanted for ALD at the Royal Prince Alfred Hospital from 1987–2004 were reviewed. Pre-transplant characteristics were rated by a psychiatrist independent of the transplant team, blind to the outcome. Outcomes were rated by a second independent alcohol treatment specialist also blind to the pre-transplant ratings. Results: Of 100 patients, 6 died before discharge from hospital, 4 had <6 months follow-up, 18 relapsed to harmful drinking, 10 drank below harmful levels, and 62 remained abstinent after a mean of 5.6 years follow-up. Univariate analyses identified six potential pre-transplant predictors of return to harmful drinking. These were a diagnosis of mental illness (of which all cases were of depression), the lack of a stable partner, grams per day consumed in the years before assessment for transplant, reliance on ‘family or friends’ for post-transplant support, tobacco consumption at time of assessment, and lack of insight into the alcohol aetiology. Duration of pre-transplant abstinence and social class by occupation did not predict relapse. A multivariate model based on the above characteristics correctly predicted 89% of the outcomes. Conclusion: A model based on readily defined behaviours and psychosocial factors predicted relapse to harmful drinking after transplant for ALD. This model may improve assessment and post-transplant management of patients with advanced ALD.
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  A. De Gottardi, L. Spahr, P. Gelez, I. Morard, G. Mentha, O. Guillaud, P. Majno, P. Morel, A. Hadengue, P. Paliard, et al. A Simple Score for Predicting Alcohol Relapse After Liver Transplantation: Results From 387 Patients Over 15 Years Arch Intern Med, June 11, 2007; 167(11): 1183 - 1188. [Abstract] [Full Text] [PDF]
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