title: Predictors of heavy drinking after liver transplantation for alcoholic liver disease in Denmark (1990-2013): a nationwide study with competing risks analyses.
abstract: OBJECTIVE
  Heavy drinking following liver transplantation decreases survival. Little is known of predictors of heavy drinking, which should guide clinicians identifying patients at high risk of return to heavy drinking after transplantation.
  
  
  METHODS
  We calculated the cumulative incidence of heavy drinking among patients transplanted for alcoholic liver disease in Denmark 1990-2013. We then analyzed pre-transplant demographic and psychiatric characteristics as predictors of post-transplant heavy drinking. Information was obtained from medical records, from nationwide registries and by interview.
  
  
  RESULTS
  Among 156 liver-transplanted patients, the cumulative incidence of heavy drinking was 18%, 24% and 27% after 5, 10 and 15 years post-transplant. In univariate analyses of pre-transplant predictors of heavy drinking after transplantation, younger age (p < 0.001), being retired (p = 0.007), anxiety (p = 0.04), personality disorder (p = 0.05) and no lifetime diagnosis of alcohol dependence (p = 0.03) were associated with heavy drinking after transplantation. Smoking (p = 0.06) tended to be associated, whereas depression (p = 0.7) or being married was not (p = 0.7). In the multivariate analysis, only younger age (p = 0.03), being retired (p = 0.007) and no lifetime diagnosis of alcohol dependence (p = 0.003) remained significant predictors. Heavy drinking after transplantation decreased survival beyond 5 years post-transplant (p = 0.004).
  
  
  CONCLUSIONS
  There is a high incidence of heavy drinking after liver transplantation for alcoholic cirrhosis in Denmark. Younger age, being retired and no lifetime diagnosis of alcohol dependence were predictors of heavy drinking after transplantation.
authors.affiliation: a 1 Department of Hepatology, Copenhagen University Hospital , Rigshospitalet, Copenhagen, Denmark.|b 2 National Institute of Public Health, University of Southern Denmark , Copenhagen, Denmark.
authors.forename: Gro
authors.initials: G
authors.lastname: Askgaard
authors.affiliation: b 2 National Institute of Public Health, University of Southern Denmark , Copenhagen, Denmark.
authors.forename: Janne S
authors.initials: JS
authors.lastname: Tolstrup
authors.affiliation: c 3 Department of Biostatistics, University of Copenhagen , Copenhagen, Denmark.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Gerds
authors.affiliation: a 1 Department of Hepatology, Copenhagen University Hospital , Rigshospitalet, Copenhagen, Denmark.
authors.forename: Ole
authors.initials: O
authors.lastname: Hamberg
authors.affiliation: d 4 Department of Respiratory Medicine, Bispebjerg Hospital , Copenhagen, Denmark.
authors.forename: Louise
authors.initials: L
authors.lastname: Zierau
authors.affiliation: a 1 Department of Hepatology, Copenhagen University Hospital , Rigshospitalet, Copenhagen, Denmark.
authors.forename: Mette S
authors.initials: MS
authors.lastname: Kjær
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology* / Q000401:mortality; D000437:Alcoholism / Q000453:epidemiology; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008104:Liver Cirrhosis, Alcoholic / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012179:Retirement; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D055815:Young Adult
keywords: alcohol recidivism; alcoholic liver disease; competing risk; liver transplantation; survival