A PEth-based assessment of alcohol relapse and predictors after liver transplantation for alcohol-related liver disease.
Source: PubMed, NCBI / U.S. National Library of Medicine
Alcohol-related liver disease (ALD) is a major indication for liver transplantation (LT) and post-LT alcohol relapses remain a key concern. We evaluated the risk and predictors in a nationwide ALD cohort using phosphatidylethanol (PEth), a direct biomarker of alcohol consumption. We retrospectively analyzed all adults transplanted for ALD in Finland 2018-2023. Alcohol relapse was defined as any relapse (PEth ≥ 0.03 µmol/L) or severe relapse (PEth ≥ 0.30 µmol/L). Cumulative incidence was estimated using competing-risk time-to-event methods, and predictors were examined using univariable Cox proportional hazards models. Among 95 patients (median post-LT follow-up 4.3 years), 29 (31%) experienced any relapse and 13 of those (14%) severe relapse. Limited social support (HR 2.81, 95% CI 1.32-5.95) and insufficient assessment of alcohol use disorder (AUD) (HR 2.93, 95% CI 1.34-6.41) were associated with increased risk of any relapse, while involvement of a relative during LT evaluation (HR 0.28, 95% CI 0.10-0.72) and a formal diagnosis of alcohol dependence (HR 0.15, 95% CI 0.03-0.76) were protective. Older age reduced the risk of severe relapse (HR 0.93 per year, 95% CI 0.88-0.99). Among those transplanted within ≤6 months of pre-transplant abstinence ( = 9), 78% experienced any relapse and 44% developed severe relapse. In this national Finnish ALD cohort, approximately one third of LT recipients experienced
Abstract
Alcohol-related liver disease (ALD) is a major indication for liver transplantation (LT) and post-LT alcohol relapses remain a key concern. We evaluated the risk and predictors in a nationwide ALD cohort using phosphatidylethanol (PEth), a direct biomarker of alcohol consumption. We retrospectively analyzed all adults transplanted for ALD in Finland 2018-2023. Alcohol relapse was defined as any relapse (PEth ≥ 0.03 µmol/L) or severe relapse (PEth ≥ 0.30 µmol/L). Cumulative incidence was estimated using competing-risk time-to-event methods, and predictors were examined using univariable Cox proportional hazards models. Among 95 patients (median post-LT follow-up 4.3 years), 29 (31%) experienced any relapse and 13 of those (14%) severe relapse. Limited social support (HR 2.81, 95% CI 1.32-5.95) and insufficient assessment of alcohol use disorder (AUD) (HR 2.93, 95% CI 1.34-6.41) were associated with increased risk of any relapse, while involvement of a relative during LT evaluation (HR 0.28, 95% CI 0.10-0.72) and a formal diagnosis of alcohol dependence (HR 0.15, 95% CI 0.03-0.76) were protective. Older age reduced the risk of severe relapse (HR 0.93 per year, 95% CI 0.88-0.99). Among those transplanted within ≤6 months of pre-transplant abstinence ( = 9), 78% experienced any relapse and 44% developed severe relapse. In this national Finnish ALD cohort, approximately one third of LT recipients experienced alcohol relapse. Short pre-transplant abstinence and indicators of limited support and suboptimal AUD assessment were associated with higher relapse risk, underscoring the need for sustained addiction treatment and consistent support post-LT.