Risk factors and outcomes associated with alcohol relapse after liver transplantation

Table 1 Definitions of alcohol use after liver transplantation

Study	Term	Definition
Lucey et al[21]	Harmful drinking	Consumption of 4 or more drinks in one day or drinking for 4 or more days in succession
	Occasional slip	Consumption of a limited amount of alcohol, followed by immediate procedures to re-establish abstinence
De Gottardi et al[11]	Harmful drinking	Consumption greater than 40 g/d that is associated with the presence of alcohol-related damage, such as histologic features of alcoholic liver injury on biopsy
Diagnostic and Statistical Manual of Mental Disorders Version IV	Alcohol abuse	Meeting one of the following criteria during a 12 mo period: Use which causes failure to fulfill major role obligations at work, school or home, use which causes a hazardous situation, use which causes legal problems or use continuing in the setting of recurrent social or interpersonal problems
World Health Organization	Occasional consumption	Men: < 20 g/d
		Women: < 30 g/d
	Excessive consumption	Men: > 20 g/d
		Women: > 30 g/d

Table 2 Risk factors associated with alcohol relapse

Risk Factor	Ref.	Study design	Sample size	Results
Abstinence less than 6 mo pre-LT	Perney et al[26] (2005)	Retrospective	n = 61	Associated with severe relapse to heavy drinking1
	De Gottardi et al[11] (2007)	Retrospective	n = 387	Associated with relapse
	Pfitzmann et al[15] (2007)	Retrospective	n = 300	Associated with relapse
	Tandon et al[30] (2009)	Retrospective	n = 171	For every 1-mo increment increase in pre-transplant abstinence, there was a 5% decrease in the adjusted relapse rate
	Karim et al[29] (2010)	Retrospective	n = 80	Associated with relapse and is an independent risk factor for relapse
	Satapathy et al[42] (2015)	Retrospective	n = 148	Associated with alcohol relapse
	Osorio et al[28] (1994)	Retrospective	n = 43	No association
	Jauhar et al[27] (2004)	Retrospective	n = 112	No association
	Björnsson et al[8] (2005)	Retrospective	n = 103	No association
	Addolorato et al[25] (2013)	Retrospective	n = 55	No association
	Egawa et al[40] (2014)	Retrospective	n = 140	No association
Abstinence < 1 yr pre-LT	Kelly et al[31] (2006)	Retrospective	n = 100	No association with harmful relapse2
	Gedaly et al[79] (2008)	Retrospective	n = 142	Independent predictor of relapse
Age	Perney et al[26] (2005)	Retrospective	n = 61	Alcohol relapse group was younger compared to the non-relapse group
	Pfitzmann et al[15] (2007)	Retrospective	n = 300	Age < 40 yr of age was associated with relapse, but was not an independent risk factor
	Karim et al[29] (2010)	Retrospective	n = 80	Age < 50 yr of age approached clinical significance for alcohol relapse
	Rice et al[14] (2013)	Retrospective	n = 300	Alcohol relapse group was younger compared to the non-relapse group
	Grąt et al[38] (2014)	Retrospective	n = 97	Younger age < 45 associated with relapse
	Satapathy et al[42] (2015)	Retrospective	n = 148	Older patients had lower likelihood of alcohol relapse
	De Gottardi et al[11] (2007)	Retrospective	n = 387	Age > 50 yr associated with relapse
	Jauhar et al[27] (2004)	Retrospective	n = 112	No association
	Björnsson et al[8] (2005)	Retrospective	n = 103	No association
Social support	Kelly et al[31] (2006)	Retrospective	n = 100	Lack of partner associated with harmful alcohol relapse2
	Pfitzmann et al[15] (2007)	Retrospective	n = 300	Absence of life companion associated with increased risk of alcohol relapse
	DiMartini et al[13] (2006)	Prospective	n = 167	Marriage is protective against binge use
	Rodrigue et al[39] (2013)	Retrospective	n = 118	Limited social support associated with alcohol relapse
	Egawa et al[40] (2014)	Retrospective	n = 140	Marital status associated with alcohol relapse and harmful relapse3
	Satapathy et al[42] (2015)	Retrospective	n = 148	Support from immediate family (spouse, parent or child) was highly correlated with reduced risk of alcohol relapse
Marital status	Björnsson et al[8] (2005)	Retrospective	n = 103	No association
Psychiatric condition	De Gottardi et al[11] (2007)	Retrospective	n = 387	Associated with relapse
	Karim et al[29] (2010)	Retrospective	n = 80	Associated with relapse
	Kelly et al[31] (2006)	Retrospective	n = 100	Previous diagnosis of a mental illness associated with harmful drinking2
	DiMartini et al[13] (2006)	Prospective	n = 167	History of depressive disorder associated with alcohol relapse
	Egawa et al[40] (2014)	Retrospective	n = 140	A history of treatment for psychological diseases other than alcoholism before LT is associated with risk of alcohol relapse but not harmful drinking3
	Jauhar et al[27] (2004)	Retrospective	n = 112	Comorbid psychiatric condition had no association with relapse
Employment	Jauhar et al[27] (2004)	Retrospective	n = 112	No association
	Perney et al[26] (2005)	Retrospective	n = 61	No association
	Kelly et al[31] (2006)	Retrospective	n = 100	Previous occupation not associated with harmful drinking
	Egawa et al[40] (2014)	Retrospective	n = 140	Post-LT occupational status not associated with alcohol relapse
	Satapathy et al[42] (2015)	Retrospective	n = 148	Employment status at time of transplant was not associated with alcohol relapse
Cigarette smoking	Pageaux et al[17] (2003)	Retrospective	n = 128	Occasional and heavy drinkers were more likely to be cigarette smokers compared to abstinent patients
	Kelly et al[31] (2006)	Retrospective	n = 100	Median cigarette use per day was higher in harmful alcohol relapse group
	Rodrigue et al[56] (2013)	Retrospective	n = 118	Associated with alcohol relapse
	Egawa et al[40] (2014)	Retrospective	n = 140	Cigarette smoking after LT associated with alcohol relapse
	Satapathy et al[42] (2015)	Retrospective	n = 148	Active cigarette smoking at time of LT associated with alcohol relapse
Non-compliance with clinic visits	Egawa et al[40] (2014)	Retrospective	n = 140	Associated with alcohol relapse and harmful relapse3
Pre-LT substance abuse or alcohol treatment	DiMartini et al[13] (2006)	Prospective	n = 167	Prior alcohol rehabilitation was associated with relapse
	Gedaly et al[79] (2008)	Retrospective	n = 142	Participation in rehabilitation was associated with relapse
	Jauhar et al[27] (2004)	Retrospective	n = 112	Substance abuse treatment before LT had no association with relapse
	Björnsson et al[8] (2005)	Retrospective	n = 103	No association

¹Alcohol consumption of more than 21 units per week for males and 14 units per week for females;

²Alcohol consumption greater than 140 g of ethanol per week;

³Alcohol consumption greater than 40 g per day that was associated with the presence of alcohol-related damage. LT: Liver transplantation.