Introduction Alcohol-related liver disease (ALD) is one of the commonest indications for liver transplantation, but relapse to drinking alcohol in this group of patients is a significant concern. Clarification of risk factors that can predict relapse is needed in the UK, so that additional support can be provided for those at increased risk.
Methods Patients being considered for liver transplantation as a result of ALD in Leeds undergo thorough assessment by an alcohol professional. Particular emphasis is placed on the risk of recidivism to drinking, using 2 scoring systems. One of these, the High-risk Alcohol Relapse (HRAR) Score, focuses on prior alcohol consumption history, whereas the Relative Risk Factors for Relapse (RRFR) Score addresses psychosocial dysfunction. However, neither of these scoring systems is used to determine suitability for transplantation.
Scores were evaluated in those known to have returned to drinking alcohol after listing for transplantation, either by self-report or by random blood alcohol testing. These scores were compared to listed patients considered to be abstinent. We also assessed whether duration of self-reported abstinence or family history of alcoholism were greater in those who relapsed.
Results Between September 2008 and August 2010, 58 people with ALD were listed for liver transplantation. Of these, 12 are known to have returned to drinking alcohol, either whilst listed or post-transplant.
There was no significant difference in the relapsers compared to the non-relapsers according to gender (0.67% vs 0.73% were males, P = 0.45) or age (median 50 vs 54 years, P = 0.09).
The median RRFR scores were significantly higher in the relapsers compared to the non-relapsers (14.5/27 vs 12/27; P = 0.01). The median HRAR scores were identical in the 2 groups (median scores 2/6; P = 0.28).
There was no significant difference in duration of self-reported abstinence between relapsers and non-relapsers (13 vs 10 months; P = 0.26). There was also no difference in family history (where known) of alcoholism between the 2 groups (1/10 vs 8/39; P = 0.4).
Conclusion Psychosocial dysfunction is significantly greater in patients with ALD who relapse to drinking alcohol following listing for transplantation. Psychological support may therefore reduce the risk of relapse in these patients. The predictive utility of the HRAR score was poor in this cohort of patients.
Disclosure of Interest None Declared.
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