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Predicting Low Risk for Sustained Alcohol Use After Early Liver Transplant for Acute Alcoholic Hepatitis: The Sustained Alcohol Use Post-Liver Transplant Score.
Hepatology. 2019 04; 69(4):1477-1487.Hep

Abstract

Early liver transplant (LT) for alcohol-associated disease (i.e., without a specific sobriety period) is controversial but increasingly used. Using the multicenter American Consortium of Early Liver Transplantation for Alcoholic Hepatitis (ACCELERATE-AH) cohort, we aimed to develop a predictive tool to identify patients pretransplant with low risk for sustained alcohol use posttransplant to inform selection of candidates for early LT. We included consecutive ACCELERATE-AH LT recipients between 2012 and 2017. All had clinically diagnosed severe alcoholic hepatitis (AH), no prior diagnosis of liver disease or AH, and underwent LT without a specific sobriety period. Logistic and Cox regression, classification and regression trees (CARTs), and least absolute shrinkage and selection operator (LASSO) regression were used to identify variables associated with sustained alcohol use post-LT. Among 134 LT recipients for AH with median period of alcohol abstinence pre-LT of 54 days, 74% were abstinent, 16% had slips only, and 10% had sustained alcohol use after a median 1.6 (interquartile range [IQR]: 0.7-2.8) years follow-up post-LT. Four variables were associated with sustained use of alcohol post-LT, forming the Sustained Alcohol Use Post-LT (SALT) score (range: 0-11): >10 drinks per day at initial hospitalization (+4 points), multiple prior rehabilitation attempts (+4 points), prior alcohol-related legal issues (+2 points), and prior illicit substance abuse (+1 point). The C statistic was 0.76 (95% confidence interval [CI]: 0.68-0.83). A SALT score ≥5 had a 25% positive predictive value (95% CI: 10%-47%) and a SALT score of <5 had a 95% negative predictive value (95% CI: 89%-98%) for sustained alcohol use post-LT. In internal cross-validation, the average C statistic was 0.74.

Conclusion:

A prognostic score, the SALT score, using four objective pretransplant variables identifies candidates with AH for early LT who are at low risk for sustained alcohol use posttransplant. This tool may assist in the selection of patients with AH for early LT or in guiding risk-based interventions post-LT.

Authors+Show Affiliations

Department of Gastroenterology, University of California, San Francisco, San Francisco, CA.Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA.Department of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.Department of Gastroenterology, Keck School of Medicine, University of Southern California, Los Angeles, CA.Department of Gastroenterology, Ochsner Medical Center, Jefferson, LA.Department of Gastroenterology, Swedish Medical Center, Seattle, WA.Department of Gastroenterology, Houston Methodist Hospital, Houston, TX.Department of Gastroenterology, School of Medicine, University of Maryland, Baltimore, MD.Department of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY.Department of Gastroenterology, Carver College of Medicine, University of Iowa, Iowa City, IA.Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI.Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI.Department of Gastroenterology, Rush Medical College, Chicago, IL.Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD.Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD.Department of Gastroenterology, Feinberg School of Medicine, Northwestern University, Chicago, IL.Department of Gastroenterology, University of California, San Francisco, San Francisco, CA.

Pub Type(s)

Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30561766

Citation

Lee, Brian P., et al. "Predicting Low Risk for Sustained Alcohol Use After Early Liver Transplant for Acute Alcoholic Hepatitis: the Sustained Alcohol Use Post-Liver Transplant Score." Hepatology (Baltimore, Md.), vol. 69, no. 4, 2019, pp. 1477-1487.
Lee BP, Vittinghoff E, Hsu C, et al. Predicting Low Risk for Sustained Alcohol Use After Early Liver Transplant for Acute Alcoholic Hepatitis: The Sustained Alcohol Use Post-Liver Transplant Score. Hepatology. 2019;69(4):1477-1487.
Lee, B. P., Vittinghoff, E., Hsu, C., Han, H., Therapondos, G., Fix, O. K., Victor, D. W., Dronamraju, D., Im, G. Y., Voigt, M. D., Rice, J. P., Lucey, M. R., Eswaran, S., Chen, P. H., Li, Z., Maddur, H., & Terrault, N. A. (2019). Predicting Low Risk for Sustained Alcohol Use After Early Liver Transplant for Acute Alcoholic Hepatitis: The Sustained Alcohol Use Post-Liver Transplant Score. Hepatology (Baltimore, Md.), 69(4), 1477-1487. https://doi.org/10.1002/hep.30478
Lee BP, et al. Predicting Low Risk for Sustained Alcohol Use After Early Liver Transplant for Acute Alcoholic Hepatitis: the Sustained Alcohol Use Post-Liver Transplant Score. Hepatology. 2019;69(4):1477-1487. PubMed PMID: 30561766.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predicting Low Risk for Sustained Alcohol Use After Early Liver Transplant for Acute Alcoholic Hepatitis: The Sustained Alcohol Use Post-Liver Transplant Score. AU - Lee,Brian P, AU - Vittinghoff,Eric, AU - Hsu,Christine, AU - Han,Hyosun, AU - Therapondos,George, AU - Fix,Oren K, AU - Victor,David W, AU - Dronamraju,Deepti, AU - Im,Gene Y, AU - Voigt,Michael D, AU - Rice,John P, AU - Lucey,Michael R, AU - Eswaran,Sheila, AU - Chen,Po-Hung, AU - Li,Zhiping, AU - Maddur,Haripriya, AU - Terrault,Norah A, Y1 - 2019/03/05/ PY - 2018/05/29/received PY - 2018/09/23/accepted PY - 2018/12/19/pubmed PY - 2020/5/30/medline PY - 2018/12/19/entrez SP - 1477 EP - 1487 JF - Hepatology (Baltimore, Md.) JO - Hepatology VL - 69 IS - 4 N2 - Early liver transplant (LT) for alcohol-associated disease (i.e., without a specific sobriety period) is controversial but increasingly used. Using the multicenter American Consortium of Early Liver Transplantation for Alcoholic Hepatitis (ACCELERATE-AH) cohort, we aimed to develop a predictive tool to identify patients pretransplant with low risk for sustained alcohol use posttransplant to inform selection of candidates for early LT. We included consecutive ACCELERATE-AH LT recipients between 2012 and 2017. All had clinically diagnosed severe alcoholic hepatitis (AH), no prior diagnosis of liver disease or AH, and underwent LT without a specific sobriety period. Logistic and Cox regression, classification and regression trees (CARTs), and least absolute shrinkage and selection operator (LASSO) regression were used to identify variables associated with sustained alcohol use post-LT. Among 134 LT recipients for AH with median period of alcohol abstinence pre-LT of 54 days, 74% were abstinent, 16% had slips only, and 10% had sustained alcohol use after a median 1.6 (interquartile range [IQR]: 0.7-2.8) years follow-up post-LT. Four variables were associated with sustained use of alcohol post-LT, forming the Sustained Alcohol Use Post-LT (SALT) score (range: 0-11): >10 drinks per day at initial hospitalization (+4 points), multiple prior rehabilitation attempts (+4 points), prior alcohol-related legal issues (+2 points), and prior illicit substance abuse (+1 point). The C statistic was 0.76 (95% confidence interval [CI]: 0.68-0.83). A SALT score ≥5 had a 25% positive predictive value (95% CI: 10%-47%) and a SALT score of <5 had a 95% negative predictive value (95% CI: 89%-98%) for sustained alcohol use post-LT. In internal cross-validation, the average C statistic was 0.74. Conclusion: A prognostic score, the SALT score, using four objective pretransplant variables identifies candidates with AH for early LT who are at low risk for sustained alcohol use posttransplant. This tool may assist in the selection of patients with AH for early LT or in guiding risk-based interventions post-LT. SN - 1527-3350 UR - https://www.unboundmedicine.com/medline/citation/30561766/Predicting_Low_Risk_for_Sustained_Alcohol_Use_After_Early_Liver_Transplant_for_Acute_Alcoholic_Hepatitis:_The_Sustained_Alcohol_Use_Post_Liver_Transplant_Score_ L2 - https://doi.org/10.1002/hep.30478 DB - PRIME DP - Unbound Medicine ER -