Fixed Versus Growth Mindset and the Association With Alcohol Relapse After Liver Transplantation

Alcohol relapse after liver transplant (LT) is a concern for transplant centers across the US. Relapse rates have been quoted between 10% and 50%, making identification of patients with the lowest risk a priority when selecting LT recipients. Fixed vs growth mindset is a concept in psychology often applied to motivation, which may predict post-LT outcomes.

We retrospectively phoned patients who were transplanted for alcohol-related liver disease (ALD) between May 2016 and April 2023. Patients were consented over the phone and asked about their alcohol use, tobacco use, and were administered the growth mindset questionnaire. Mindset scores ranged from 0 to 60, with higher scores indicating stronger growth mindset.

We identified 82 patients of whom 46 (56%) consented and completed surveys. Of these 46 LT recipients, 17 (37%) endorsed post-LT alcohol use while 29 (63%) stated abstinence. Self-reporting correlated well with random phosphatidylethanol testing. Mindset scores had identical median values between self-reported relapse groups. Patients who admitted to relapse were more likely to have failed attempts at alcohol rehabilitation and to have experienced legal consequences due to alcohol use. There were 25 patients in the cohort who used tobacco at any point. Those who were able to quit tobacco use before LT comprised a significantly higher portion of those without relapse (52%) compared to those who relapsed (18%).

Predicting relapse in patients with ALD who await LT remains a challenge. However, successful cessation of tobacco may indicate successful abstinence from alcohol use post-LT. These results warrant further study with larger populations.