Division of Hepatology and Sandra Atlas Bass Center for Liver Diseases & Transplantation, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Manhasset, United States, USA.
College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
Clin Transplant. 2020 Sep;34(9):e14003. doi: 10.1111/ctr.14003. Epub 2020 Jul 6.
Alcohol-associated liver disease (AALD) is a rapidly growing indication for liver transplantation (LT). We aimed to examine various clinical, demographic, and behavioral factors to predict post-LT alcohol relapse and graft survival.
Retrospective analysis was performed on 241 LT recipients with AALD as either a primary or secondary indication for LT (2006-2015).
Patients with <6 months of alcohol abstinence had significantly increased cumulative incidence for alcohol relapse compared to those with >6 months of abstinence (P = .0041, Log-Rank). We identified four variables to predict harmful alcohol relapse post-LT: age at LT, non-alcohol-related criminal history, pre-LT abstinence period (Ref >6 months of alcohol abstinence), and drinks per day (Ref <10 drinks/day). Area under the curve (AUC) for the final model was 0.79 (95% CI: 0.68-0.91). Our multivariable model was evaluated with internal cross-validation; random sampling of the study subjects 100 times yielded a median C statistic of 75 (±SD 0.097) and accuracy of 91 (±SD 0.026). The four-variable model served to form the harmful alcohol use post-LT (HALT) score. Graft survival remained significantly lower in patients with <6 months of pre-LT alcohol abstinence and those with blue-collar jobs.
The HALT score identifies LT candidates with AALD at significant risk for alcohol relapse, potentially guiding transplant centers for pre- and post-LT interventions for improved patient outcomes.
酒精相关性肝病（AALD）是肝移植（LT）的一个快速增长的适应证。我们旨在研究各种临床、人口统计学和行为因素，以预测 LT 后酒精复发和移植物存活率。
对 241 名 AALD 作为 LT 的主要或次要适应证的 LT 受者进行回顾性分析（2006-2015 年）。
与戒酒>6 个月的患者相比，戒酒<6 个月的患者酒精复发的累积发生率显著增加（P=.0041，Log-Rank）。我们确定了四个变量来预测 LT 后有害的酒精复发：LT 时的年龄、非酒精相关的犯罪史、LT 前的戒酒期（参考戒酒>6 个月）和每日饮酒量（参考<10 杯/天）。最终模型的曲线下面积（AUC）为 0.79（95%CI：0.68-0.91）。我们的多变量模型通过内部交叉验证进行了评估；对研究对象进行 100 次随机抽样，得到中位数 C 统计量为 75（±SD 0.097），准确性为 91（±SD 0.026）。四变量模型用于形成 LT 后有害酒精使用（HALT）评分。LT 前戒酒<6 个月和蓝领工作的患者的移植物存活率仍然显著较低。
HALT 评分确定了 AALD 的 LT 候选者存在酒精复发的高风险，这可能为移植中心提供指导，以便进行 LT 前后的干预，从而改善患者的预后。
