Torosian Kelly, Shahrvini Bita, Johnson Willie Mohammed, Vodkin Irine, Tincopa Monica, Lim Nicholas, Kwong Allison, Ajmera Veeral
Division of Gastroenterology and Hepatology, University of California, San Diego, San Diego, California, USA.
Department of Medicine, University of California, San Diego, San Diego, California, USA.
Alcohol Clin Exp Res (Hoboken). 2024 Nov;48(11):2137-2144. doi: 10.1111/acer.15438. Epub 2024 Sep 10.
Alcohol use after liver transplant (LT) is associated with higher rates of graft loss and increased mortality; however, there are limited data evaluating predictors of return to alcohol use using biochemical markers like phosphatidylethanol (PEth).
This multicenter retrospective cohort study evaluated psychosocial predictors of return to alcohol use using PEth testing in patients transplanted for alcohol-associated liver disease (ALD). The study included 223 patients at three centers who had received a LT for ALD and had at least one PEth measurement post-LT.
The rate of return to alcohol use was 6.9 cases per 100 person-years (26 patients total) over a median 555 days of follow-up after transplant. Younger age (HR 0.96; 95% CI 0.92-0.99, p = 0.02), mental health comorbidities (HR 2.83; 95% CI 1.25-6.39, p = 0.01), and non-Hispanic White race (HR 3.79; 95% CI 1.42-10.15, p = 0.01) were associated with return to alcohol use post-LT. There was no difference between post-LT return to alcohol use rates or short-term survival among patients with less than 6 months of sobriety prior to listing compared with those with more than 6 months. Patients with sustained alcohol use post-LT had increased odds of history of illicit substance use (OR 5.20; 95% CI 1.01-26.83, p = 0.04) but no significant difference in time from the last drink to listing (OR 1.03; 95% CI 0.18-5.80, p = 0.97).
These findings emphasize the importance of mental health comorbidities rather than period of sobriety in predicting post-LT return to alcohol use. Furthermore, the higher risk of return to alcohol use in non-Hispanic White patients suggests a potential disparity with referral and selection of higher risk White patients.
肝移植（LT）后饮酒与更高的移植物丢失率和死亡率增加相关；然而，使用磷脂酰乙醇（PEth）等生化标志物评估复饮预测因素的数据有限。
这项多中心回顾性队列研究在因酒精性肝病（ALD）接受移植的患者中，使用PEth检测评估复饮的社会心理预测因素。该研究纳入了三个中心的223例因ALD接受LT且LT后至少进行过一次PEth测量的患者。
在移植后的中位555天随访期内，复饮率为每100人年6.9例（共26例患者）。较年轻的年龄（风险比[HR]0.96；95%置信区间[CI]0.92 - 0.99，p = 0.02）、合并精神疾病（HR 2.83；95% CI 1.25 - 6.39，p = 0.01）和非西班牙裔白人种族（HR 3.79；95% CI 1.42 - 10.15，p = 0.01）与LT后复饮相关。与戒酒6个月以上的患者相比，登记前戒酒少于6个月的患者LT后复饮率或短期生存率无差异。LT后持续饮酒的患者有非法药物使用史的几率增加（比值比[OR]5.20；95% CI 1.01 - 26.83，p = 0.04），但从最后一次饮酒到登记的时间无显著差异（OR 1.03；95% CI 0.18 - 5.80，p = 0.97）。
这些发现强调了合并精神疾病而非戒酒时间在预测LT后复饮中的重要性。此外，非西班牙裔白人患者复饮风险较高表明在高危白人患者的转诊和选择方面可能存在差异。
