DiMartini A, Magill J, Fitzgerald M G, Jain A, Irish W, Khera G, Yates W
Department of Psychiatry and the Thomas E Starzl Transplant Institute at the University of Pittsburgh Medical Center, Pennsylvania, USA.
Alcohol Clin Exp Res. 2000 Aug;24(8):1198-201.
Methods to improve assessment, selection, and monitoring of patients with alcoholic cirrhosis who pursue liver transplantation are sought continuously. We chose to investigate the use of the High-Risk Alcohol Relapse (HRAR) scale in our transplant population in the hope that it would improve our ability to identify and follow patients at highest risk for alcohol relapse.
Detailed alcohol histories of 207 patients evaluated for liver transplantation were collected and graded for severity by using the HRAR. The HRAR provides information on the duration of alcohol use (a measure of chronicity), daily quantity of alcohol use, and rehabilitation experiences (treatment responsiveness). Posttransplant alcohol use was monitored through clinical follow-up in the transplant clinic.
Although men and women had similar years of heavy drinking pretransplant, women's daily alcohol consumption was significantly less than men's. HRAR scores did not distinguish those listed for transplant from those not listed or those who drank posttransplant from those who did not. Transplant patients were predominantly in the low-risk group (83% had an HRAR score <4).
The HRAR did not have predictive ability in our transplant population. Few of our patients were rated as high risk, and few drank posttransplant. Nevertheless, identifying patients at high risk may improve clinical care and decrease the rate of posttransplant alcohol consumption.
人们一直在寻求改进对接受肝移植的酒精性肝硬化患者进行评估、选择和监测的方法。我们选择在我们的移植人群中研究高风险酒精复发（HRAR）量表的使用，希望它能提高我们识别和跟踪酒精复发风险最高的患者的能力。
收集了207例接受肝移植评估患者的详细饮酒史，并使用HRAR对严重程度进行分级。HRAR提供了饮酒持续时间（慢性程度的一种衡量指标）、每日饮酒量和康复经历（治疗反应性）方面的信息。通过移植诊所的临床随访监测移植后饮酒情况。
尽管男性和女性移植前重度饮酒年限相似，但女性的每日饮酒量明显低于男性。HRAR评分无法区分列入移植名单的患者与未列入名单的患者，也无法区分移植后饮酒的患者与未饮酒的患者。移植患者主要属于低风险组（83%的患者HRAR评分<4）。
HRAR在我们的移植人群中没有预测能力。我们的患者中很少有人被评为高风险，移植后饮酒的人也很少。然而，识别高风险患者可能会改善临床护理并降低移植后酒精消费率。
