PMID- 30920118
OWN - NLM
STAT- MEDLINE
DCOM- 20200817
LR  - 20200817
IS  - 1527-6473 (Electronic)
IS  - 1527-6465 (Linking)
VI  - 25
IP  - 8
DP  - 2019 Aug
TI  - Prediction of Alcohol Relapse Among Liver Transplant Candidates With Less Than 6 
      Months of Abstinence Using the High-Risk Alcoholism Relapse Score.
PG  - 1142-1154
LID - 10.1002/lt.25460 [doi]
AB  - The selection of liver transplantation (LT) candidates with alcohol-use disorder 
      (AUD) is influenced by the risk of alcohol relapse (AR) after LT. We aimed to 
      investigate the risk factors of AR after LT and its impact on graft and recipient 
      outcomes. A retrospective study was conducted that included all consecutive 
      patients with AUD undergoing LT from January 2004 to April 2016 (n = 309), 
      excluding patients with alcoholic hepatitis. Odds ratios (ORs) and 95% confidence 
      intervals (CIs) for AR were analyzed by multinomial logistic regression. Cox 
      regression with time-dependent covariates was used to analyze patient survival 
      and graft cirrhosis. There were 70 (23%) patients who presented AR (median 
      follow-up, 68 months), most of them (n = 44, 63%) presenting heavy AR. The 
      probability of heavy AR was 2.3%, 7.5%, 12%, and 29% at 1, 3, 5, and 10 years 
      after LT, respectively. The independent risk factors for heavy AR included a 
      High-Risk Alcoholism Relapse (HRAR) score >/=3 (OR, 2.39; 95% CI, 1.02-5.56; 
      P = 0.04) and the duration of abstinence (months) before LT (OR, 0.81; 95% CI, 
      0.66-0.98; P = 0.03). In recipients with <6 months of abstinence before LT, the 
      probability of heavy AR after LT was higher in patients with an HRAR score >/=3 
      than in those with an HRAR score <3 (20%, 36.7%, and 47% versus 6.8%, 12.4%, and 
      27% at 1, 3, and 5 years, respectively; log-rank 0.013). The risk of graft 
      cirrhosis was increased in patients with heavy AR (hazard ratio, 3.44; 95% CI, 
      1.58-7.57; P = 0.002) compared with nonrelapsers, with no differences in patient 
      survival. In conclusion, the HRAR score is helpful in identifying the risk of 
      harmful AR after LT in candidates with <6 months of alcohol abstinence without 
      alcoholic hepatitis. These patients could benefit from a longterm integrative 
      patient-centered approach after LT until lifestyle changes are implemented.
CI  - Copyright (c) 2019 by the American Association for the Study of Liver Diseases.
FAU - Lombardo-Quezada, Julissa
AU  - Lombardo-Quezada J
AD  - Liver Transplant Unit, Centro de Investigacion Biomedica en Red de Enfermedades 
      Hepaticas y Digestivas, Hospital Clinic, University of Barcelona, Barcelona, 
      Spain.
AD  - Grup de Recerca en Addiccions Clinic, Red de Trastornos Adictivos, Institut 
      d'Investigacions Biomediques August Pi i Sunyer, Hospital Clinic, University of 
      Barcelona, Barcelona, Spain.
FAU - Colmenero, Jordi
AU  - Colmenero J
AD  - Liver Transplant Unit, Centro de Investigacion Biomedica en Red de Enfermedades 
      Hepaticas y Digestivas, Hospital Clinic, University of Barcelona, Barcelona, 
      Spain.
AD  - Grup de Recerca en Addiccions Clinic, Red de Trastornos Adictivos, Institut 
      d'Investigacions Biomediques August Pi i Sunyer, Hospital Clinic, University of 
      Barcelona, Barcelona, Spain.
FAU - Lopez-Pelayo, Hugo
AU  - Lopez-Pelayo H
AD  - Grup de Recerca en Addiccions Clinic, Red de Trastornos Adictivos, Institut 
      d'Investigacions Biomediques August Pi i Sunyer, Hospital Clinic, University of 
      Barcelona, Barcelona, Spain.
FAU - Gavotti, Carolina
AU  - Gavotti C
AD  - Grup de Recerca en Addiccions Clinic, Red de Trastornos Adictivos, Institut 
      d'Investigacions Biomediques August Pi i Sunyer, Hospital Clinic, University of 
      Barcelona, Barcelona, Spain.
FAU - Lopez, Ana
AU  - Lopez A
AD  - Grup de Recerca en Addiccions Clinic, Red de Trastornos Adictivos, Institut 
      d'Investigacions Biomediques August Pi i Sunyer, Hospital Clinic, University of 
      Barcelona, Barcelona, Spain.
FAU - Crespo, Gonzalo
AU  - Crespo G
AD  - Liver Transplant Unit, Centro de Investigacion Biomedica en Red de Enfermedades 
      Hepaticas y Digestivas, Hospital Clinic, University of Barcelona, Barcelona, 
      Spain.
AD  - Grup de Recerca en Addiccions Clinic, Red de Trastornos Adictivos, Institut 
      d'Investigacions Biomediques August Pi i Sunyer, Hospital Clinic, University of 
      Barcelona, Barcelona, Spain.
FAU - Lopez, Eva
AU  - Lopez E
AD  - Liver Transplant Unit, Centro de Investigacion Biomedica en Red de Enfermedades 
      Hepaticas y Digestivas, Hospital Clinic, University of Barcelona, Barcelona, 
      Spain.
AD  - Grup de Recerca en Addiccions Clinic, Red de Trastornos Adictivos, Institut 
      d'Investigacions Biomediques August Pi i Sunyer, Hospital Clinic, University of 
      Barcelona, Barcelona, Spain.
FAU - Gual, Antoni
AU  - Gual A
AD  - Grup de Recerca en Addiccions Clinic, Red de Trastornos Adictivos, Institut 
      d'Investigacions Biomediques August Pi i Sunyer, Hospital Clinic, University of 
      Barcelona, Barcelona, Spain.
FAU - Lligona, Anna
AU  - Lligona A
AD  - Grup de Recerca en Addiccions Clinic, Red de Trastornos Adictivos, Institut 
      d'Investigacions Biomediques August Pi i Sunyer, Hospital Clinic, University of 
      Barcelona, Barcelona, Spain.
FAU - Navasa, Miquel
AU  - Navasa M
AD  - Liver Transplant Unit, Centro de Investigacion Biomedica en Red de Enfermedades 
      Hepaticas y Digestivas, Hospital Clinic, University of Barcelona, Barcelona, 
      Spain.
AD  - Grup de Recerca en Addiccions Clinic, Red de Trastornos Adictivos, Institut 
      d'Investigacions Biomediques August Pi i Sunyer, Hospital Clinic, University of 
      Barcelona, Barcelona, Spain.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20190625
PL  - United States
TA  - Liver Transpl
JT  - Liver transplantation : official publication of the American Association for the 
      Study of Liver Diseases and the International Liver Transplantation Society
JID - 100909185
SB  - IM
CIN - Liver Transpl. 2019 Aug;25(8):1133-1135. PMID: 31166651
MH  - Age Factors
MH  - Alcohol Abstinence/*psychology
MH  - Alcoholism/complications/*diagnosis/psychology
MH  - Allografts/pathology
MH  - Chronic Disease/psychology
MH  - Female
MH  - Follow-Up Studies
MH  - Hepatitis, Alcoholic/diagnosis/*surgery
MH  - Humans
MH  - Liver/pathology
MH  - Liver Cirrhosis, Alcoholic/*epidemiology/etiology/pathology
MH  - Liver Transplantation/*standards
MH  - Male
MH  - Middle Aged
MH  - Postoperative Complications/*epidemiology/etiology/pathology
MH  - Prognosis
MH  - Recurrence
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Risk Factors
MH  - Severity of Illness Index
MH  - Sex Factors
MH  - Time Factors
EDAT- 2019/03/29 06:00
MHDA- 2020/08/18 06:00
CRDT- 2019/03/29 06:00
PHST- 2018/08/09 00:00 [received]
PHST- 2019/03/16 00:00 [accepted]
PHST- 2019/03/29 06:00 [pubmed]
PHST- 2020/08/18 06:00 [medline]
PHST- 2019/03/29 06:00 [entrez]
AID - 10.1002/lt.25460 [doi]
PST - ppublish
SO  - Liver Transpl. 2019 Aug;25(8):1142-1154. doi: 10.1002/lt.25460. Epub 2019 Jun 25.