Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, CA.
Department of Medicine, Stanford Center for Clinical Research, Palo Alto, CA.
Transplantation. 2024 Mar 1;108(3):742-749. doi: 10.1097/TP.0000000000004800. Epub 2023 Oct 30.
The selection of liver transplant (LT) candidates with alcohol-related liver disease (ALD) is influenced by the risk of alcohol relapse (AR), yet the ability to predict AR is limited. We evaluate psychosocial factors associated with post-LT AR and compare the performance of high-risk alcoholism risk (HRAR), sustained alcohol use post-LT (SALT), and the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) scores in predicting relapse.
A retrospective analysis of ALD patients undergoing LT from 2015 to 2021 at a single US transplant center was performed. Risk factors associated with post-LT AR were evaluated and test characteristics of 3 prediction models were compared.
Of 219 ALD LT recipients, 23 (11%) had AR during a median study follow-up of 37.5 mo. On multivariate analysis, comorbid psychiatric illness (odds ratio 5.22) and continued alcohol use after advice from a health care provider (odds ratio 3.8) were found to be significantly associated with post-LT AR. On sensitivity analysis, SIPAT of 30 was optimal on discriminating between ALD LT recipients with and without post-LT AR. SIPAT outperformed both the HRAR and SALT scores (c-statistic 0.67 versus 0.59 and 0.62, respectively) in identifying post-LT AR. However, all scores had poor positive predictive value (<25%).
AR after LT is associated with comorbid psychiatric illness and lack of heeding health care provider advice to abstain from alcohol. Although SIPAT outperformed the HRAR and SALT scores in predicting AR, all are poor predictors. The current tools to predict post-LT AR should not be used to exclude LT candidacy.
选择患有酒精相关肝病（ALD）的肝移植（LT）候选者受到酒精复发（AR）风险的影响，但预测 AR 的能力有限。我们评估了与 LT 后 AR 相关的心理社会因素，并比较了高危酒精中毒风险（HRAR）、LT 后持续饮酒（SALT）和斯坦福综合移植心理社会评估（SIPAT）评分在预测复发方面的表现。
对 2015 年至 2021 年期间在美国一家移植中心接受 LT 的 ALD 患者进行了回顾性分析。评估了与 LT 后 AR 相关的危险因素，并比较了 3 种预测模型的特征。
在 219 例 ALD LT 受者中，23 例（11%）在中位研究随访 37.5 个月时发生 AR。多变量分析显示，合并精神疾病（优势比 5.22）和在医疗保健提供者建议后继续饮酒（优势比 3.8）与 LT 后 AR 显著相关。在敏感性分析中，SIPAT 得分为 30 时，在区分 LT 后有无 AR 的 ALD 受者方面表现最佳。SIPAT 在识别 LT 后 AR 方面优于 HRAR 和 SALT 评分（C 统计量分别为 0.67、0.59 和 0.62）。然而，所有评分的阳性预测值均较差（<25%）。
LT 后 AR 与合并精神疾病和不遵守医疗保健提供者戒酒建议有关。尽管 SIPAT 在预测 AR 方面优于 HRAR 和 SALT 评分，但它们都是较差的预测指标。目前用于预测 LT 后 AR 的工具不应被用于排除 LT 候选者。
