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Research Summary

What Predicts Harmful Alcohol Use After Liver Transplantation?

Patients should not drink alcohol after liver transplantation for alcoholic liver disease. To identify risk factors for alcohol use after liver transplantation, researchers analyzed pre- and post-transplantation data from 387 patients (76% male, average age 51 years) who underwent the procedure in Switzerland or France. 

  • Twelve percent of patients had harmful alcohol use* during an average follow-up of 61 months after transplantation.
  • In adjusted analyses, the following 3 factors were significantly associated with harmful alcohol use after transplantation:
    • a score of >3 on the High-Risk Alcoholism Relapse scale,** used to assess pre-transplantation alcohol use (odds ratio [OR], 10.7)
    • psychiatric comorbidity (OR, 7.8)
    • pre-transplantation abstinence from alcohol for ≤6 months (OR, 3.3)
  • Harmful alcohol use after transplantation occurred in 5% of patients with none of the above factors, in 18% with 1 factor, in 64% with 2 factors, and in 100% with all 3 factors.


This study found that pre-transplantation alcohol use, inpatient alcohol treatment, and psychiatric factors are associated with relapse to harmful alcohol use after liver transplantation for alcoholic liver disease. The outcome measure for this study required not only a fairly high daily intake of alcohol but also alcohol-related physical or mental harm. Thus, it is not clear how many patients in the “nonrelapse” group were drinking at unhealthy levels, despite recommendations to abstain after transplantation.

Kevin L. Kraemer, MD, MSc

* About >3.5 drinks of alcohol per day plus alcohol-related physical or mental consequences

**A scale from 0 to 6 points (total) based on 3 parameters: 1) duration of heavy drinking (0 points for <11 years, 1 point for 11-25 years, and 2 points for >25 years); 2) daily drinks (0 points for <9 drinks per day, 1 point for 9-17 drinks per day, and 2 points for >17 drinks per day); and 3) prior inpatient treatment for alcoholism (0 points for 0 treatments, 1 point for 1 treatment, and 2 points for >1 treatment)


De Gottardi A, Spahr L, Gelez L, et al. A simple score for predicting alcohol relapse after liver transplantation: results from 387 patients over 15 years. Arch Intern Med. 2007;167(11):1183–1188.