title: A simple score for predicting alcohol relapse after liver transplantation: results from 387 patients over 15 years.
abstract: BACKGROUND
  Alcohol relapse can negatively influence the outcome after liver transplantation (LT). The aim of our study was to identify factors that could be associated with the recurrence of harmful alcohol consumption after LT.
  
  
  METHODS
  A total of 387 consecutive patients (23.8% women) who underwent LT for alcoholic cirrhosis in Geneva, Switzerland, and Lyon, France, between 1989 and 2005 were evaluated. Mean +/- SD age was 51.3 +/- 7.5 years. Follow-up time was 61.2 +/- 47.5 months. Alcohol consumption relapse and potential factors associated with it were studied.
  
  
  RESULTS
  The relapse rate of harmful alcohol consumption after LT was 11.9%. In univariate analysis, alcohol relapse was significantly associated with age greater than 50 years (P = .04), year of LT 1995 or earlier (P<.05), duration of abstinence less than 6 months (P = .02), presence of psychiatric comorbidities (P<.001), presence of a life partner (P<.05), and a high score on the High-Risk Alcoholism Relapse (HRAR) scale (P<.001). Multivariate logistic regression disclosed the following independent factors of relapse: duration of abstinence of less than 6 months (odds ratio [OR], 3.3; 95% confidence interval [CI], 1.2-9.3) (P = .02); presence of psychiatric comorbidities (OR, 7.8; 95% CI, 3.1-20.0) (P<.001); and HRAR score higher than 3 (OR, 10.7; 95% CI, 3.8-30.0) (P = .001). In patients with none of these factors, alcohol relapse was 5%, while the presence of 1, 2, or 3 factors was associated with relapse rates of 18%, 64%, and 100% of the patients, respectively.
  
  
  CONCLUSIONS
  In a large cohort of patients undergoing LT for alcoholic cirrhosis, a duration of abstinence of less than 6 months before wait-listing for LT, the presence of psychiatric comorbidities, or an HRAR score higher than 3 was associated with relapse into harmful drinking. The presence of more than 1 factor dramatically increased this risk over 50%. In the pre-LT evaluation in this setting, these factors should be accurately determined.
authors.affiliation: Divisions of Gastroenterology and Hepatology, University Hospital, Geneva, Switzerland.
authors.forename: Andrea
authors.initials: A
authors.lastname: De Gottardi
authors.forename: Laurent
authors.initials: L
authors.lastname: Spahr
authors.forename: Pascale
authors.initials: P
authors.lastname: Gelez
authors.forename: Isabelle
authors.initials: I
authors.lastname: Morard
authors.forename: Gilles
authors.initials: G
authors.lastname: Mentha
authors.forename: Olivier
authors.initials: O
authors.lastname: Guillaud
authors.forename: Pietro
authors.initials: P
authors.lastname: Majno
authors.forename: Philippe
authors.initials: P
authors.lastname: Morel
authors.forename: Antoine
authors.initials: A
authors.lastname: Hadengue
authors.forename: Pierre
authors.initials: P
authors.lastname: Paliard
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Scoazec
authors.forename: Olivier
authors.initials: O
authors.lastname: Boillot
authors.forename: Emile
authors.initials: E
authors.lastname: Giostra
authors.forename: Jérôme
authors.initials: J
authors.lastname: Dumortier
mesh_terms: D000437:Alcoholism / Q000453:epidemiology*; D001007:Anxiety / Q000453:epidemiology; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013557:Switzerland / Q000453:epidemiology; D013997:Time Factors; D014850:Waiting Lists