HOME
Return to Table of Contents
THE DURATION OF PRE-TRANSPLANT ABSTINENCE IS AN INDEPENDENT PREDICTOR OF PROBLEM DRINKING POST LIVER TRANSPLANTATION
P Tandon, KJ Goodman, G Meeburg, D Bergston, C Hoekstra, M Carbonneau, VG Bain
Department of Medicine, University of Alberta, Edmonton, AB
BACKGROUND: Alcoholic liver disease is a common indication for liver transplantation. Rates of general recidivism (any alcohol intake post-transplant) range from 10-95%. Rates of abusive or “problem” drinking (PD) have been estimated at 8-25%. To minimize recidivism, most programs require at least 6 months of pre-transplant abstinence. There is limited data on the duration of pre-transplant abstinence in the prediction of post-transplantation PD. We aimed, therefore, to estimate the effect of pre-transplant abstinence duration on the rate of post-transplant PD.
METHODS: We conducted a retrospective review of all patients transplanted for alcohol induced liver disease (with or without concurrent indications, surviving > 3 months post-transplant). PD was defined as clinically significant alcohol use post-transplant (any drinking to the point of intoxication or “heavy” drinking (>20 grams/day in women and >40 grams/day in men) on at least 2 separate occasions). We used Cox proportional hazards regression to estimate rate (hazard) ratios (RR) as a measure of association.
RESULTS: Of 213 eligible transplant patients, 39 were excluded (16 had survival <3 months post transplant and 23 had incomplete data). Of the 174 remaining patients, 79% were male with a mean (±SD) age of 52.1 ± 7.6 years. The mean follow-up time was 64.8 ± 42.6 months (total person-months at risk of relapse=9,661). The mean pre-transplant abstinence was 40.4 ± 51.6 months. The risk of general recidivism was 24% (41/174). Among patients who drank again, 54% (22/41 or 13% of 174) were PD. The risk of PD for pre-transplant abstinence durations of <= 6 months, 7-12 months, 13-17 months, 18-35 months, and => 36 months was 38%, 27%, 18%, 5%, and 4%, respectively. Among various measured patient attributes, pre-transplant abstinence duration was the strongest predictor of general recidivism and PD post-transplant; no measured variable appeared to substantially confound this association. Compared to an abstinence duration of => 36 months, the RR (95% CI) for PD was 7.6 (1.3, 46), 5.1 (1.1, 24), 3.7 (0.75, 19), 1.0 (0.14, 7.2) for abstinence durations of <= 6 months, 7-12 months, 13-17 months and 18-35 months, respectively. Although 25% of patients had >36 months of pre-transplant abstinence, there were no PD identified in this group (maximum duration in PD=36 months).
CONCLUSIONS: These results support the current requirement for at least 6 months of pre-transplant abstinence. Patients with durations of abstinence <18 months may benefit from more intensive follow-up and rehabilitation post-transplant.