Shenoy Akhil, Dienstag Aryeh, Dienstag Penina, Ford Laura, Schubert Elizabeth, Wankoff Margot, Mohan Kanwal, Mirza Omar, Bhardwaj Meera, Im Gene
Department of Psychiatry, Columbia University Medical Center, United States of America.
Hadassah Hebrew University Medical Center, Jerusalem, Israel.
Gen Hosp Psychiatry. 2021 Sep-Oct;72:23-30. doi: 10.1016/j.genhosppsych.2021.06.012. Epub 2021 Jun 28.
Early liver transplantation (LT) is considered for patients with alcohol use disorder (AUD) despite limited sober time when acute mortality risk from liver disease is high. The objective of this paper is to find psychosocial tools that do not rely on extended sober time and predict alcohol relapse post-LT.
We conducted a systematic review of Pubmed, Embase, and Scopus for studies testing psychosocial tools that used numeric scoring to predict post-LT alcohol relapse. Tools that afforded points for length of sobriety were excluded. Each study was analyzed for its clinical context, post-LT relapse outcomes and predictive validity.
Five scoring systems across fourteen samples showed varied validity in predicting post-LT alcohol relapse. Relapse to any alcohol use after LT revealed an average relapse rate of 23%. Most scoring systems were understudied but four of five provided cut-off scores with high negative predictive values for relapse.
Scoring systems may have a place in candidate selection but the data on cut-off scores and predictability are still lacking for their use alone in high stakes LT selection. Larger studies with prospective scoring and standardized follow ups for relapse post-LT will better allow the predictive validity of these psychosocial tools to be compared.
对于患有酒精使用障碍（AUD）的患者，尽管清醒时间有限，但当肝病导致的急性死亡风险很高时，会考虑进行早期肝移植（LT）。本文的目的是寻找不依赖延长清醒时间且能预测肝移植后酒精复发的心理社会工具。
我们对PubMed、Embase和Scopus进行了系统综述，以查找测试使用数字评分来预测肝移植后酒精复发的心理社会工具的研究。为清醒时长计分的工具被排除。对每项研究的临床背景、肝移植后复发结果和预测有效性进行了分析。
14个样本中的5个评分系统在预测肝移植后酒精复发方面显示出不同的有效性。肝移植后任何酒精使用的复发显示平均复发率为23%。大多数评分系统研究不足，但五个中有四个提供了对复发具有高阴性预测值的临界值分数。
评分系统在候选者选择中可能有一席之地，但仅在高风险肝移植选择中单独使用时，关于临界值分数和可预测性的数据仍然缺乏。对肝移植后复发进行前瞻性评分和标准化随访的更大规模研究将能更好地比较这些心理社会工具的预测有效性。
