A simple score for predicting alcohol relapse after liver transplantation - Results from 387 patients over 15 years

Background: Alcohol relapse can negatively influence the outcome after liver transplantation ( LT). The aim of our study was to identify factors that could be associated with the recurrence of harmful alcohol consumption after LT. Methods: A total of 387 consecutive patients ( 23.8% women) who underwent LT for alcoholic cirrhosis in Geneva, Switzerland, and Lyon, France, between 1989 and 2005 were evaluated. Mean +/- SD age was 51.3 +/- 7.5 years. Follow-up time was 61.2 +/- 47.5 months. Alcohol consumption relapse and potential factors associated with it were studied. Results: The relapse rate of harmful alcohol consumption after LT was 11.9%. In univariate analysis, alcohol relapse was significantly associated with age greater than 50 years ( P = .04), year of LT 1995 or earlier ( P < .05), duration of abstinence less than 6 months ( P = .02), presence of psychiatric comorbidities ( P < .001), presence of a life partner ( P < .05), and a high score on the High-Risk Alcoholism Relapse ( HRAR) scale ( P < .001). Multivariate logistic regression disclosed the following independent factors of relapse: duration of abstinence of less than 6 months ( odds ratio [ OR], 3.3; 95% confidence interval [ CI], 1.2-9.3) ( P = .02); presence of psychiatric comorbidities ( OR, 7.8; 95% CI, 3.1-20.0) ( P < .001); and HRAR score higher than 3 ( OR, 10.7; 95% CI, 3.8-30.0) ( P = .001). In patients with none of these factors, alcohol relapse was 5%, while the presence of 1, 2, or 3 factors was associated with relapse rates of 18%, 64%, and 100% of the patients, respectively. Conclusions: In a large cohort of patients undergoing LT for alcoholic cirrhosis, a duration of abstinence of less than 6 months before wait-listing for LT, the presence of psychiatric comorbidities, or an HRAR score higher than 3 was associated with relapse into harmful drinking. The presence of more than 1 factor dramatically increased this risk over 50%. In the pre-LT evaluation in this setting, these factors should be accurately determined.