Brian P Lee1, Eric Vittinghoff2, Christine Hsu3, Hyosun Han4, George Therapondos5, Oren K Fix6, David W Victor7, Deepti Dronamraju8, Gene Y Im9, Michael D Voigt10, John P Rice11, Michael R Lucey11, Sheila Eswaran12, Po-Hung Chen13, Zhiping Li13, Haripriya Maddur14, Norah A Terrault1. 1. Department of Gastroenterology, University of California, San Francisco, San Francisco, CA. 2. Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA. 3. Department of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. 4. Department of Gastroenterology, Keck School of Medicine, University of Southern California, Los Angeles, CA. 5. Department of Gastroenterology, Ochsner Medical Center, Jefferson, LA. 6. Department of Gastroenterology, Swedish Medical Center, Seattle, WA. 7. Department of Gastroenterology, Houston Methodist Hospital, Houston, TX. 8. Department of Gastroenterology, School of Medicine, University of Maryland, Baltimore, MD. 9. Department of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY. 10. Department of Gastroenterology, Carver College of Medicine, University of Iowa, Iowa City, IA. 11. Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI. 12. Department of Gastroenterology, Rush Medical College, Chicago, IL. 13. Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD. 14. Department of Gastroenterology, Feinberg School of Medicine, Northwestern University, Chicago, IL.
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.
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: Miaoyan Wei; Jin Xu; Jie Hua; Qingcai Meng; Chen Liang; Jiang Liu; Bo Zhang; Wei Wang; Xianjun Yu; Si Shi Journal: Front Immunol Date: 2021-04-23 Impact factor: 7.561
Authors: Sumeet K Asrani; James Trotter; Jack Lake; Aijaz Ahmed; Anthony Bonagura; Andrew Cameron; Andrea DiMartini; Stevan Gonzalez; Gene Im; Paul Martin; Philippe Mathurin; Jessica Mellinger; John P Rice; Vijay H Shah; Norah Terrault; Anji Wall; Scott Winder; Goran Klintmalm Journal: Liver Transpl Date: 2020-01 Impact factor: 5.799