Kelly Maria, Chick Jonathan, Gribble Robert, Gleeson Margaret, Holton Mathew, Winstanley Julie, McCaughan Geoffrey W, Haber Paul S
Alcohol Problems Service, Royal Edinburgh Hospital, Scotland.
Alcohol Alcohol. 2006 May-Jun;41(3):278-83. doi: 10.1093/alcalc/agh257. Epub 2006 Feb 13.
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.
This study examined novel postulated predictors of relapse to drinking.
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.
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.
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.
终末期酒精性肝病（ALD）是肝移植的常见适应症。结果可能因恢复有害饮酒而受限。先前的研究几乎未发现饮酒复发的预测因素。
本研究检验了新提出的饮酒复发预测因素。
回顾了1987年至2004年在皇家阿尔弗雷德王子医院接受ALD移植的所有患者的病历。移植前特征由一名独立于移植团队的精神科医生进行评估，该医生对结果不知情。结果由另一名独立的酒精治疗专家进行评估，该专家也对移植前评估不知情。
100例患者中，6例在出院前死亡，4例随访时间不足6个月，18例恢复有害饮酒，10例饮酒量低于有害水平，62例在平均5.6年的随访后仍保持戒酒。单因素分析确定了六个潜在的移植前有害饮酒复发预测因素。这些因素包括精神疾病诊断（所有病例均为抑郁症）、缺乏稳定伴侣、移植评估前几年的每日饮酒量、移植后依靠“家人或朋友”提供支持、评估时吸烟以及对酒精病因缺乏洞察力。移植前戒酒时间和职业社会阶层不能预测复发。基于上述特征的多变量模型正确预测了89%的结果。
基于易于定义的行为和社会心理因素的模型可预测ALD移植后有害饮酒的复发。该模型可能会改善晚期ALD患者的评估和移植后管理。
