title: Alcohol drinking after liver transplantation is associated with graft injury.
abstract: OBJECTIVE
  This was a single-center, mixed-design, cross-sectional and retrospective study to assess the performance of the 4-item, self-reported CAGE (Cut down, Annoyed, Guilty, Eye-opener) questionnaire in predicting histology-proven alcohol-related liver graft injury (ARLGI).
  
  
  METHODS
  A total of 316 liver transplant (LT) patients between six months and five years were enrolled. Based on previous research, problem alcohol drinking (PAD) was defined as any score ≥ 1 on the CAGE, while a cut-off of 2 was assumed for alcohol dependence (AD).
  
  
  RESULTS
  Responders were 195, 45 (23.1%) had a CAGE score ≥ 1 and 30 (15.3%) scored ≥ 2. After controlling for confounders, PAD was associated with hyperlipidemia (P=0.01), while AD with a male gender (P=0.01), hyperlipidemia (P=0.03) and alcohol as native diagnosis (P=0.03). PAD and AD were both associated with a significantly higher prevalence of ARLGI, i.e. 53.3% and 63.3%, respectively (P<0.0001). Hepatitis C virus (HCV) patients with PAD showed more steatosis (P=0.04), portal infiltrate (P=0.03), and pericellular/perivenular fibrosis (P=0.02). The likelihood ratios for CAGE scores ranging from 0 to 4 in predicting ARLGI were 0, 5.2, 7.8, 7.8, and 100, respectively.
  
  
  CONCLUSIONS
  By use of a self-report instrument we found a 23.1% prevalence of PAD and a 15.3% prevalence of AD among LT patients between six months and five years. A variable degree of ARLGI was present in 53.3% of PAD and 63.3% of AD, respectively. HCV patients with PAD had more steatosis, portal inflammation, and pericellular fibrosis. Transplant physicians might improve their ability to predict the probability for ARLGI using the CAGE.
authors: General Surgery and Liver Transplantation Unit, Department of Liver Transplantation, Hepatology, and Infectious Disease, University of Pisa Medical School Hospital, Pisa, Italy. p.desimone@ao-pisa.toscana.it
authors: P
authors: P
authors: De Simone
authors: S
authors: S
authors: De Geest
authors: J
authors: J
authors: Ducci
authors: P
authors: P
authors: Carrai
authors: S
authors: S
authors: Petruccelli
authors: L
authors: L
authors: Baldoni
authors: L
authors: L
authors: Pollina
authors: D
authors: D
authors: Campani
authors: F
authors: F
authors: Filipponi
mesh_terms: D000428:Alcohol Drinking / Q000009:adverse effects*; D000465:Algorithms; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000209:etiology*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires