Alcohol-associated liver disease (AALD) is an increasingly common indication for liver transplantation (LT). In the present study, Satapathy and colleagues sought to assess different clinical, demographic, and behavioral factors for predicting post-LT alcohol relapse and graft survival.

This retrospective analysis was conducted among 241 LT recipients with AALD either as a primary or secondary indication for LT from 2006-2015.

It was noted that patients with less than 6 months of alcohol abstinence had significantly higher cumulative incidence for alcohol relapse in comparison with those who had >6 months of abstinence. Four variables were identified to predict harmful alcohol relapse after LT. These included age at LT, non-alcohol-related criminal history, pre-LT abstinence period (Ref >6 months of alcohol abstinence), and number of drinks per day (Ref <10 drinks/day). Area under the curve (AUC) for the final model was found to be 0.79 (95% CI: 0.68-0.91).

The multivariable model was assessed with internal cross-validation; random sampling of the study participants 100 times gave a median C statistic of 75 (±SD 0.097) with an accuracy of 91 (±SD 0.026). The four-variable model formed the harmful alcohol use post-LT (HALT) score. Graft survival was shown to be significantly lower in patients with <6 months of pre-LT alcohol abstinence and those with blue-collar jobs.

It was concluded that the HALT score could identify LT candidates with AALD at significant risk for alcohol relapse and could have a role in guiding transplant centers for pre- and post-LT interventions.

Source: Satapathy SK, Thornburgh C, Heda R, et al. Predicting harmful alcohol relapse after liver transplant: The HALT score. Clin Transplant. 2020 Jun 7;e14003.