Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA.
Division of Gastroenterology & Hepatology, University of Wisconsin-Madison, Madison, Wisconsin, USA.
Hepatol Commun. 2023 Jan 10;7(1):e0017. doi: 10.1097/HC9.0000000000000017. eCollection 2023 Jan 1.
Our research showed that patients with alcohol-associated liver disease (ALD) had more severe liver disease than those without a diagnosis of ALD yet were less likely to be selected for transplant listing due to their increased psychosocial vulnerability. This study aims to answer whether this vulnerability translates to worse short-term outcomes after transplant listing.
A total of 187 patients were approved for liver transplant listing and are included in the present retrospective study. We collected dates of transplantation, retransplantation, death, and pathologic data for evidence of rejection, and reviewed alcohol biomarkers and documentation for evidence of alcohol use.
The ALD cohort had higher Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) scores (39.4 vs. 22.5, p <0.001) and Model for End-Stage Liver Disease (MELD)-Na scores (25.0 vs. 18.5, p <0.001) compared with the non-ALD cohort. Forty-nine (59.7%) subjects with ALD and 60 (57.1%, p =0.71) subjects without ALD subsequently received a liver transplant. Overall mortality was similar between the 2 groups (20.7% ALD vs. 21.0% non-ALD, p =0.97). Neither the SIPAT score (HR: 0.98, 95% CI: 0.96-1.00, p =0.11) nor MELD-Na score (HR 0.99, 95% CI 0.95-1.02, p =0.40) were associated with mortality. Patients with ALD were more likely to have alcohol biomarkers tested both before (84.1% vs. 24.8% non-ALD, p <0.001) and after liver transplantation (74.0% vs. 16.7% non-ALD, p <0.001). SIPAT score was associated with alcohol use after listing (OR: 1.03, 95% CI: 1.0-1.07, p =0.04), although a return to alcohol use was not associated with mortality (HR: 1.60, 95% CI: 0.63-4.10, p =0.33).
Patients with ALD had higher psychosocial risk compared with patients without a diagnosis of ALD who were placed on the waitlist, but had similar short-term outcomes including mortality, transplantation, and rejection. Although a high SIPAT score was predictive of alcohol use, in the short-term, alcohol use after transplant listing was not associated with mortality.
我们的研究表明，患有酒精相关性肝病（ALD）的患者的肝病比未被诊断为 ALD 的患者更严重，但由于他们的心理社会脆弱性增加，他们更不可能被选入移植名单。本研究旨在回答这种脆弱性是否会转化为移植后短期结果的恶化。
共有 187 名患者被批准进行肝移植，并被纳入本回顾性研究。我们收集了移植、再次移植、死亡和排斥的病理数据，并审查了酒精生物标志物和酒精使用的文件。
ALD 组的斯坦福综合心理社会评估移植（SIPAT）评分（39.4 分与 22.5 分，p <0.001）和终末期肝病模型-钠（MELD-Na）评分（25.0 分与 18.5 分，p <0.001）均高于非-ALD 组。49 名（59.7%）ALD 患者和 60 名（57.1%，p =0.71）非-ALD 患者随后接受了肝移植。两组的总体死亡率相似（ALD 为 20.7%，非-ALD 为 21.0%，p =0.97）。SIPAT 评分（HR：0.98，95%CI：0.96-1.00，p =0.11）和 MELD-Na 评分（HR：0.99，95%CI：0.95-1.02，p =0.40）均与死亡率无关。ALD 患者在移植前（84.1%与非-ALD 组的 24.8%，p <0.001）和移植后（74.0%与非-ALD 组的 16.7%，p <0.001）更有可能进行酒精生物标志物检测。SIPAT 评分与列入名单后的饮酒行为有关（OR：1.03，95%CI：1.0-1.07，p =0.04），尽管重新饮酒与死亡率无关（HR：1.60，95%CI：0.63-4.10，p =0.33）。
与未被诊断为 ALD 但被列入等候名单的患者相比，ALD 患者的心理社会风险更高，但短期结果（包括死亡率、移植和排斥）相似。尽管 SIPAT 评分较高预测了饮酒行为，但在短期内，移植后饮酒与死亡率无关。
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