Predicting Low Risk for Sustained Alcohol Use After Early Liver Transplant for Acute Alcoholic Hepatitis: The Sustained Alcohol Use Post-Liver Transplant Score
Predicting Low Risk for Sustained Alcohol Use After Early Liver Transplant for Acute Alcoholic Hepatitis: The Sustained Alcohol Use Post-Liver Transplant Score
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DOI：
10.1002/hep.30478
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发表时间：
2019-04-01
期刊：
影响因子：
13.5
通讯作者：
Terrault, Norah A.
中科院分区：
文献类型：
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作者：
Lee, Brian P.;Vittinghoff, Eric;Terrault, Norah A.
酒精相关疾病的早期肝移植(LT)(即，没有特定的戒酒期)是有争议的，但越来越多地被使用。利用多中心美国酒精性肝炎早期肝移植联合会(ACCESS-AH)队列，我们的目标是开发一种预测工具，以识别移植前低风险的移植后持续饮酒的患者，以便为选择早期肝移植的候选人提供信息。我们纳入了2012至2017年间连续接受Accelerate-AH LT的患者。所有患者均曾被临床诊断为重型酒精性肝炎，无肝病或酒精性肝炎的先前诊断，并在没有特定清醒期间的情况下接受了肝移植。使用Logistic和Cox回归、分类和回归树(CART)和最小绝对收缩和选择算子(LASSO)回归来识别与术后持续饮酒相关的变量。134例肝移植受者中，肝移植前戒酒时间中位数为54天的受者中，74%戒酒，16%仅滑倒，10%在术后平均1.6年(四分位数范围：0.7~2.8)后持续饮酒。有四个变量与术后持续饮酒有关，构成了术后持续饮酒(SALT)评分(范围：0-11)：首次住院时每天饮酒10杯(+4分)、既往多次康复尝试(+4分)、既往与酒精有关的法律问题(+2分)以及既往非法药物滥用(+1分)。C统计量为0.76(95%可信区间：0.68~0.83)。SALT评分=5有25%的阳性预测值(95%可信区间：10%-47%)，SALT评分为
Early liver transplant (LT) for alcohol-associated disease (i.e., without a specific sobriety period) is controversial but increasingly used. Using the multicenter American Consortium of Early Liver Transplantation for Alcoholic Hepatitis (ACCELERATE-AH) cohort, we aimed to develop a predictive tool to identify patients pretransplant with low risk for sustained alcohol use posttransplant to inform selection of candidates for early LT. We included consecutive ACCELERATE-AH LT recipients between 2012 and 2017. All had clinically diagnosed severe alcoholic hepatitis (AH), no prior diagnosis of liver disease or AH, and underwent LT without a specific sobriety period. Logistic and Cox regression, classification and regression trees (CARTs), and least absolute shrinkage and selection operator (LASSO) regression were used to identify variables associated with sustained alcohol use post-LT. Among 134 LT recipients for AH with median period of alcohol abstinence pre-LT of 54 days, 74% were abstinent, 16% had slips only, and 10% had sustained alcohol use after a median 1.6 (interquartile range [IQR]: 0.7-2.8) years follow-up post-LT. Four variables were associated with sustained use of alcohol post-LT, forming the Sustained Alcohol Use Post-LT (SALT) score (range: 0-11): >10 drinks per day at initial hospitalization (+4 points), multiple prior rehabilitation attempts (+4 points), prior alcohol-related legal issues (+2 points), and prior illicit substance abuse (+1 point). The C statistic was 0.76 (95% confidence interval [CI]: 0.68-0.83). A SALT score >= 5 had a 25% positive predictive value (95% CI: 10%-47%) and a SALT score of