Utility of scores to predict alcohol use after liver transplant: Take them with a grain of salt.

Autor:	Houston K; Department of Internal Medicine, Virginia Commonwealth University Health System, Richmond, Virginia, USA., Duong N; Department of Internal Medicine, Virginia Commonwealth University Health System, Richmond, Virginia, USA.; Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University Health System, Richmond, Virginia, USA.; Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA., Sterling RK; Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University Health System, Richmond, Virginia, USA.; Hume-Lee Transplant Center, Virginia Commonwealth University Health System, Richmond, Virginia, USA., Asgharpour A; Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University Health System, Richmond, Virginia, USA.; Hume-Lee Transplant Center, Virginia Commonwealth University Health System, Richmond, Virginia, USA., Bullock S; Hume-Lee Transplant Center, Virginia Commonwealth University Health System, Richmond, Virginia, USA., Weinland S; Hume-Lee Transplant Center, Virginia Commonwealth University Health System, Richmond, Virginia, USA., Keller N; Hume-Lee Transplant Center, Virginia Commonwealth University Health System, Richmond, Virginia, USA., Smirnova E; Hume-Lee Transplant Center, Virginia Commonwealth University Health System, Richmond, Virginia, USA., Khan H; Department of Internal Medicine, Virginia Commonwealth University Health System, Richmond, Virginia, USA., Matherly S; Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University Health System, Richmond, Virginia, USA.; Hume-Lee Transplant Center, Virginia Commonwealth University Health System, Richmond, Virginia, USA., Wedd J; Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University Health System, Richmond, Virginia, USA.; Hume-Lee Transplant Center, Virginia Commonwealth University Health System, Richmond, Virginia, USA., Lee H; Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University Health System, Richmond, Virginia, USA.; Hume-Lee Transplant Center, Virginia Commonwealth University Health System, Richmond, Virginia, USA., Siddiqui M; Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University Health System, Richmond, Virginia, USA.; Hume-Lee Transplant Center, Virginia Commonwealth University Health System, Richmond, Virginia, USA., Patel V; Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University Health System, Richmond, Virginia, USA.; Hume-Lee Transplant Center, Virginia Commonwealth University Health System, Richmond, Virginia, USA., Arias A; Department of Psychiatry, Virginia Commonwealth School of Medicine, and the VCU Institute for Drug and Alcohol Studies, Richmond, Virginia, USA., Kumaran V; Hume-Lee Transplant Center, Virginia Commonwealth University Health System, Richmond, Virginia, USA., Lee S; Hume-Lee Transplant Center, Virginia Commonwealth University Health System, Richmond, Virginia, USA., Sharma A; Hume-Lee Transplant Center, Virginia Commonwealth University Health System, Richmond, Virginia, USA., Khan A; Hume-Lee Transplant Center, Virginia Commonwealth University Health System, Richmond, Virginia, USA., Imai D; Hume-Lee Transplant Center, Virginia Commonwealth University Health System, Richmond, Virginia, USA., Levy M; Hume-Lee Transplant Center, Virginia Commonwealth University Health System, Richmond, Virginia, USA., Bruno D; Hume-Lee Transplant Center, Virginia Commonwealth University Health System, Richmond, Virginia, USA.
Jazyk:	angličtina
Zdroj:	Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society [Liver Transpl] 2024 Dec 01; Vol. 30 (12), pp. 1281-1288. Date of Electronic Publication: 2024 May 23.
DOI:	10.1097/LVT.0000000000000407
Abstrakt:	The Sustained Alcohol use post-Liver Transplant (SALT) and the High-Risk Alcohol Relapse (HRAR) scores were developed to predict a return to alcohol use after a liver transplant (LT) for alcohol-associated liver disease. A retrospective analysis of deceased donor LT from October 2018 to April 2022 was performed. All patients underwent careful pre-LT psychosocial evaluation. Data on alcohol use, substance abuse, prior rehabilitation, and legal issues were collected. After LT, all were encouraged to participate in rehabilitation programs and underwent interval phosphatidylethanol testing. Patients with alcohol-associated liver disease were stratified by < or > 6 months of sobriety before listing. Those with <6 months were further stratified as acute alcoholic hepatitis (AH) by NIAAA criteria and non-AH. The primary outcome was the utility of the SALT (<5 vs. ≥5) and HRAR (<3 vs. ≥3) scores to predict a return to alcohol use (+phosphatidylethanol) within 1 year after LT. Of the 365 LT, 86 had > 6 months of sobriety, and 85 had <6 months of sobriety; 41 with AH and 44 non-AH. In those with AH, the mean time of abstinence to LT was 58 days, and 71% failed prior rehabilitation. Following LT, the return to drinking was similar in the AH (24%) compared to <6-month non-AH (15%) and >6-month alcohol-associated liver disease (22%). Only 4% had returned to heavy drinking. The accuracy of both the SALT and HRAR scores to predict a return to alcohol was low (accuracy 61%-63%) with poor sensitivity (46% and 37%), specificity (67%-68%), positive predictive value (22%-26%) with moderate negative predictive value (81%-83%), respectively with higher negative predictive values (95%) in predicting a return to heavy drinking. Both SALT and HRAR scores had good negative predictive value in identifying patients at low risk for recidivism. (Copyright © 2024 American Association for the Study of Liver Diseases.)
Databáze:	MEDLINE
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