Factors Having an Impact on Relapse and Survival in Transplant Recipients With Alcohol-Induced Liver Disease

Terry D Schneekloth; Juan P Arab; Douglas A Simonetto; Tanya M Petterson; Shehzad K Niazi; Daniel K Hall-Flavin; Victor M Karpyak; Bhanu P Kolla; James E Roth; Walter K Kremers; Charles B Rosen

doi:10.1016/j.mayocpiqo.2021.10.005

Factors Having an Impact on Relapse and Survival in Transplant Recipients With Alcohol-Induced Liver Disease

Mayo Clin Proc Innov Qual Outcomes. 2021 Dec 8;5(6):1153-1164. doi: 10.1016/j.mayocpiqo.2021.10.005. eCollection 2021 Dec.

Authors

Terry D Schneekloth¹, Juan P Arab², Douglas A Simonetto^{3

4}, Tanya M Petterson⁵, Shehzad K Niazi⁶, Daniel K Hall-Flavin⁷, Victor M Karpyak⁷, Bhanu P Kolla⁷, James E Roth⁸, Walter K Kremers^{4

5}, Charles B Rosen^{4

9}

Affiliations

¹ Department of Psychiatry & Psychology, Mayo Clinic, Scottsdale, AZ.
² Department of Gastroenterology and Hepatology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
³ Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
⁴ William J. von Liebig Transplant Center, Mayo Clinic, Rochester, MN.
⁵ Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN.
⁶ Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL.
⁷ Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN.
⁸ Allina Health, Minneapolis, MN.
⁹ Department of Surgery, Mayo Clinic, Rochester, MN.

Abstract

Objective: To assess the impact of standardized pretransplant alcohol abstinence and treatment guidelines on liver transplant outcomes.

Methods: This study assessed the posttransplant relapse and survival associated with a pretransplant guideline mandating alcohol abstinence, addiction treatment, and Alcoholics Anonymous (AA) attendance. This retrospective cohort study included liver recipients with alcohol-induced liver disease transplanted between January 1, 2000, and December 31, 2012, at a Midwest transplant center. Cox regression models tested for associations between pretransplant treatment, demographic and clinical characteristics, and outcome measures.

Results: Of 236 liver recipients (188 [79.7%] male; 210 [89%] white; mean follow-up, 88.6±55.0 months), 212 (90.2%) completed pretransplant treatment and 135 (57.2%) attended AA weekly. At 5 years, 16.3% and 8.2% had relapsed to any alcohol use and to high-dose drinking, respectively. Smoking during the 6 months before transplant was associated with any relapse (P=.0002) and high-dose relapse (P<.0001), and smoking at transplant was associated with death (P=.001). High-dose relapse was associated with death (hazard ratio, 3.5; P<.0001).

Conclusion: A transplant center with a guideline requiring abstinence, treatment, and AA participation experienced lower posttransplant relapse rates from those previously reported in comparable large US transplant programs. Smoking cessation may further improve posttransplant outcomes.

Keywords: AA, Alcoholics Anonymous; ALD, alcoholic liver disease; NIAAA, National Institute on Alcohol Abuse and Alcoholism.