Factors Associated With Return to Alcohol Use Following Liver Transplant

Return to alcohol use after liver transplant (LT) is associated with an increased risk of graft loss and mortality; many patients with alcohol-associated liver disease (ALD) are required to demonstrate a period of sobriety prior to LT. This US multicenter retrospective cohort study investigated factors associated with return to alcohol use among adults who received LT for ALD between January 2018 and December 2020, with at least one available phosphatidylethanol (PEth; a direct alcohol biomarker) test to assess alcohol use pre- and post-transplantation.

• The study population (N=233) was 70 percent male, with median age of 52; 27 percent identified as Hispanic/Latino. Eighty-nine percent of patients had a diagnosis of alcohol use disorder; 32 percent had a diagnosis of substance use disorder.
• Over a median of 555 days of follow-up, 26 patients returned to alcohol use (6.9 cases per 100 person-years). The mean PEth value for those returning to alcohol use was 244 ng/mL, suggesting hazardous levels of drinking; the median time to return to use was 348 days.
• Psychiatric comorbidities were associated with an increased risk of return to alcohol use (hazard ratio [HR], 2.83), and younger age with a decreased risk (HR, 0.96).
• Non-Hispanic White patients had an increased risk of return to alcohol use (HR, 3.79), with a shorter time to return to use, compared with non-White patients.
• Thirty-three percent of patients had fewer than six months of sobriety before LT; this was not associated with an increased risk of return to alcohol use, nor with time to return to use.

Comments: These findings suggest that mandated periods of sobriety prior to LT receipt may not be reliable predictors of post-LT return to alcohol use or survival among patients with ALD. Moreover, patients with psychiatric comorbidities should be identified and offered additional support pre- and post-LT. The association with race/ethnicity suggests that racial bias may be a factor in LT eligibility; this potential disparity should be investigated.

Nicolas Bertholet, MD, MSc

Reference: Torosian K, Shahrvini B, Johnson WM Jr, et al. Psychosocial predictors of return to alcohol use after liver transplant: a multicenter cohort study. Alcohol Clin Exp Res. 2024;48(11):2137–2144.