Table 1. Variables associated with alcohol relapse in patients with ALD.
| Variables | Notes | Transplant population | Associated alcohol relapse | |||
|---|---|---|---|---|---|---|
| Pre | Post | Slip | Heavy* | |||
| Demographics | ||||||
| Age (24) | Age >50 associated with relapse risk post-LT | + | + | + | ||
| Sex (25) | Women more likely than men to relapse on the waiting list | + | + | |||
| Tobacco use (26,27) | History of smoking more likely to relapse post-LT | + | + | + | ||
| Alcohol use | ||||||
| Continued alcohol use (27) | Continued alcohol use after the formal diagnosis of ALD by a hepatologist associated with relapse post-LT | + | + | |||
| Quantity (24,28,29) | Higher drinks per day and longer years of heavy alcohol consumption associated with increased relapse risk | + | + | + | ||
| Alcohol dependence (17,30) | Diagnosis of pre-transplant alcohol dependence associated with relapse post-LT | + | + | + | ||
| Abstinence (17,24,26,29-33) | Fewer months sober pre-transplant associated with relapse post-LT | + | + | + | + | |
| Rehabilitation (28-30,33,34) | Attendance of a rehabilitation program pre-transplant associated with relapse post-LT | + | + | + | + | |
| Treatment motivation (27,28) | Reluctance to participate in alcohol relapse prevention program associated with increased risk for relapse | + | + | |||
| Consumption consequence (27) | Lack of consumption consequences to employment, income, housing, relationship, or legal matters | + | + | |||
| Self-admission to hospital (28) | Self-admission for treatment of ALD associated with decreased relapse risk | + | + | + | ||
| Legal issues (28,29) | History of alcohol-related legal issues associated with increased risk for relapse | + | + | + | ||
| Family history (17,28,30,34) | Having first degree biologic relatives with AUD associated with relapse post-LT | + | + | + | ||
| Psychiatric factors | ||||||
| Other substance use (17,29,30,34) | Substance use other than alcohol pre-transplant associated with relapse post-LT | + | + | + | ||
| Depression (26,30) | History of depression pre-LT associated with relapse post-LT | + | + | |||
| Perceived stress (17,27) | Reporting perceived stress and poor stress management associated with risk for relapse post-LT | + | + | + | ||
| Confidence (17) | Lack of confidence of receiving another liver if necessary associated with early relapse | + | + | + | ||
| Psychiatric comorbidity (26,28) | Patients with a history of any psychiatric comorbidity were more likely to relapse post-LT | + | + | + | ||
| Personality disorder (35) | Personality disorders associated with relapse | + | + | + | ||
| Medical factors | ||||||
| Noncompliance (35) | Noncompliance was defined as missing a single clinic appointment without contact for rescheduling, missed medication doses, or failure to refill prescription | + | + | + | ||
| Poorer health, fatigue, and bodily pain post LT (17) | Reporting poorer health, fatigue, bodily pain post-LT were more likely to relapse post-LT | + | + | + | ||
| Presence of hepatocellular carcinoma (27) | Absence of hepatocellular carcinoma in patients with ALD associated with increased relapse risk | + | + | |||
| Socioeconomics | ||||||
| Employment (28) | Employment immediately prior to hospitalization for ALD was associated with increased risk for relapse | + | + | + | ||
| Married (24,26,28,30) | Marriage pre-LT associated with decreased risk for relapse post-LT | + | + | + | ||
| Sober sponsor (27,28) | Failure to establish a rehabilitation relationship with another person, i.e., patient identifies a person as their sober sponsor, associates with increased risk for relapse | + | + | |||
| Social support (27,28) | Patient reported lack of social support (none or limited) associates with increased risk for relapse | + | + | |||
| Social events (27) | Continued participation in social events with alcohol present associated with increased risk for alcohol relapse | + | + | |||
| Scores | ||||||
| HRAR (24,36) | Higher HRAR associated with increased relapse risk. The HRAR is a score based on the duration of heavy drinking years, the number of daily drinks, and the number of prior alcoholism treatments | + | + | + | ||
| ARRA (27) | Assigns a point to nine risk factors predictive of alcohol relapse with higher scores more predictive of relapse | + | + | + | ||
| HPSS (28) | Assigns points to the following risk factors to assess alcohol relapse risk, with higher scores suggestive of increased relapse risk | + | + | + | ||
| SALT (29) | Patients with lower scores were at decreased risk for relapse post-LT; points were given for >10 drinks per day, ≥2 failed rehabilitation attempts, history of alcohol-related legal issues, history of non-tetrahydrocannabinol illicit substance use | + | + | + | ||
*, Includes binge and/or sustained relapse outcomes. ALD, alcohol-related liver disease; AUD, alcohol use disorder; HRAR, High-Risk Alcohol Relapse; ARRA, Alcohol Relapse Risk Assessment; HPSS, Hopkins Psychosocial Scoring System; SALT, Sustained Alcohol Use Post-LT; LT, liver transplantation.