Predicting Low Risk for Sustained Alcohol Use After Early Liver Transplant for Acute Alcoholic Hepatitis: The...

Area of Science:

• Hepatology
• Transplantation Surgery
• Addiction Medicine

Background:

• Early liver transplantation (LT) for alcohol-associated disease, bypassing strict sobriety requirements, is gaining traction but remains controversial.
• Identifying patients at low risk for sustained alcohol use post-LT is crucial for successful outcomes.

Purpose of the Study:

• To develop and validate a predictive tool to identify pretransplant candidates with severe alcoholic hepatitis (AH) at low risk for sustained alcohol use after LT.
• To inform the selection process for early LT in patients with AH.

Main Methods:

• Utilized the American Consortium of Early Liver Transplantation for Alcoholic Hepatitis (ACCELERATE-AH) cohort of 134 LT recipients for AH.
• Employed logistic regression, Cox regression, classification and regression trees (CARTs), and least absolute shrinkage and selection operator (LASSO) regression.
• Developed the Sustained Alcohol Use Post-LT (SALT) score based on four pretransplant variables.

Main Results:

• 10% of patients demonstrated sustained alcohol use post-LT after a median follow-up of 1.6 years.
• The SALT score incorporates: >10 drinks/day (4 pts), multiple rehab attempts (4 pts), prior legal issues (2 pts), and prior illicit substance abuse (1 pt).
• A SALT score <5 had a 95% negative predictive value for sustained alcohol use, while a score ≥5 had a 25% positive predictive value.

Conclusions:

• The SALT score is a validated prognostic tool using objective pretransplant variables to identify AH patients suitable for early LT with low risk of sustained alcohol use.
• This score can aid in patient selection for early LT or guide post-transplant risk-stratified interventions.