title: Use of a high-risk alcohol relapse scale in evaluating liver transplant candidates.
abstract: BACKGROUND
  Methods to improve assessment, selection, and monitoring of patients with alcoholic cirrhosis who pursue liver transplantation are sought continuously. We chose to investigate the use of the High-Risk Alcohol Relapse (HRAR) scale in our transplant population in the hope that it would improve our ability to identify and follow patients at highest risk for alcohol relapse.
  
  
  METHODS
  Detailed alcohol histories of 207 patients evaluated for liver transplantation were collected and graded for severity by using the HRAR. The HRAR provides information on the duration of alcohol use (a measure of chronicity), daily quantity of alcohol use, and rehabilitation experiences (treatment responsiveness). Posttransplant alcohol use was monitored through clinical follow-up in the transplant clinic.
  
  
  RESULTS
  Although men and women had similar years of heavy drinking pretransplant, women's daily alcohol consumption was significantly less than men's. HRAR scores did not distinguish those listed for transplant from those not listed or those who drank posttransplant from those who did not. Transplant patients were predominantly in the low-risk group (83% had an HRAR score <4).
  
  
  CONCLUSIONS
  The HRAR did not have predictive ability in our transplant population. Few of our patients were rated as high risk, and few drank posttransplant. Nevertheless, identifying patients at high risk may improve clinical care and decrease the rate of posttransplant alcohol consumption.
authors.affiliation: Department of Psychiatry and the Thomas E Starzl Transplant Institute at the University of Pittsburgh Medical Center, Pennsylvania, USA. dimartiniaf@msx.upmc.edu
authors.forename: A
authors.initials: A
authors.lastname: DiMartini
authors.forename: J
authors.initials: J
authors.lastname: Magill
authors.forename: M G
authors.initials: MG
authors.lastname: Fitzgerald
authors.forename: A
authors.initials: A
authors.lastname: Jain
authors.forename: W
authors.initials: W
authors.lastname: Irish
authors.forename: G
authors.initials: G
authors.lastname: Khera
authors.forename: W
authors.initials: W
authors.lastname: Yates
mesh_terms: D000328:Adult; D000368:Aged; D000437:Alcoholism; D015331:Cohort Studies; D000431:Ethanol / Q000097:blood; D005260:Female; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors
chemical_list: D000431:Ethanol