TY - JOUR
T1 - Factors Having an Impact on Relapse and Survival in Transplant Recipients With Alcohol-Induced Liver Disease
AU - Schneekloth, Terry D.
AU - Arab, Juan P.
AU - Simonetto, Douglas A.
AU - Petterson, Tanya M.
AU - Niazi, Shehzad K
AU - Hall-Flavin, Daniel K.
AU - Karpyak, Victor M.
AU - Kolla, Bhanu P.
AU - Roth, James E.
AU - Kremers, Walter K.
AU - Rosen, Charles
N1 - Publisher Copyright:
© 2021 The Authors
PY - 2021/12
Y1 - 2021/12
N2 - Objective: To assess the impact of standardized pretransplant alcohol abstinence and treatment guidelines on liver transplant outcomes. Methods: This study assessed the posttransplant relapse and survival associated with a pretransplant guideline mandating alcohol abstinence, addiction treatment, and Alcoholics Anonymous (AA) attendance. This retrospective cohort study included liver recipients with alcohol-induced liver disease transplanted between January 1, 2000, and December 31, 2012, at a Midwest transplant center. Cox regression models tested for associations between pretransplant treatment, demographic and clinical characteristics, and outcome measures. Results: Of 236 liver recipients (188 [79.7%] male; 210 [89%] white; mean follow-up, 88.6±55.0 months), 212 (90.2%) completed pretransplant treatment and 135 (57.2%) attended AA weekly. At 5 years, 16.3% and 8.2% had relapsed to any alcohol use and to high-dose drinking, respectively. Smoking during the 6 months before transplant was associated with any relapse (P=.0002) and high-dose relapse (P<.0001), and smoking at transplant was associated with death (P=.001). High-dose relapse was associated with death (hazard ratio, 3.5; P<.0001). Conclusion: A transplant center with a guideline requiring abstinence, treatment, and AA participation experienced lower posttransplant relapse rates from those previously reported in comparable large US transplant programs. Smoking cessation may further improve posttransplant outcomes.
AB - Objective: To assess the impact of standardized pretransplant alcohol abstinence and treatment guidelines on liver transplant outcomes. Methods: This study assessed the posttransplant relapse and survival associated with a pretransplant guideline mandating alcohol abstinence, addiction treatment, and Alcoholics Anonymous (AA) attendance. This retrospective cohort study included liver recipients with alcohol-induced liver disease transplanted between January 1, 2000, and December 31, 2012, at a Midwest transplant center. Cox regression models tested for associations between pretransplant treatment, demographic and clinical characteristics, and outcome measures. Results: Of 236 liver recipients (188 [79.7%] male; 210 [89%] white; mean follow-up, 88.6±55.0 months), 212 (90.2%) completed pretransplant treatment and 135 (57.2%) attended AA weekly. At 5 years, 16.3% and 8.2% had relapsed to any alcohol use and to high-dose drinking, respectively. Smoking during the 6 months before transplant was associated with any relapse (P=.0002) and high-dose relapse (P<.0001), and smoking at transplant was associated with death (P=.001). High-dose relapse was associated with death (hazard ratio, 3.5; P<.0001). Conclusion: A transplant center with a guideline requiring abstinence, treatment, and AA participation experienced lower posttransplant relapse rates from those previously reported in comparable large US transplant programs. Smoking cessation may further improve posttransplant outcomes.
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U2 - 10.1016/j.mayocpiqo.2021.10.005
DO - 10.1016/j.mayocpiqo.2021.10.005
M3 - Article
AN - SCOPUS:85130462862
SN - 2542-4548
VL - 5
SP - 1153
EP - 1164
JO - Mayo Clinic Proceedings: Innovations, Quality and Outcomes
JF - Mayo Clinic Proceedings: Innovations, Quality and Outcomes
IS - 6
ER -