A simple score for predicting alcohol relapse after liver transplantation - Results from 387 patients over 15 years
A simple score for predicting alcohol relapse after liver transplantation - Results from 387 patients over 15 years
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DOI：
10.1001/archinte.167.11.1183
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发表时间：
2007-06-11
影响因子：
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通讯作者：
Dumortier, Jerome
中科院分区：
文献类型：
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作者：
De Gottardi, Andrea;Spahr, Laurent;Dumortier, Jerome
背景：酒精复发会对肝移植（LT）后的结果产生负面影响。我们的研究的目的是确定因素，可能与复发的有害酒精消费后LT。方法：共387例连续患者（23.8%的妇女）谁接受LT酒精性肝硬化在日内瓦，瑞士和里昂，法国，1989年至2005年进行了评估。平均+/- SD年龄为51.3 +/- 7.5岁。随访时间为61.2 ± 47.5个月。结果：肝移植术后有害饮酒复发率为11.9%。在单变量分析中，酒精复发与年龄大于50岁显著相关（P = .04），LT年份1995或更早（P < .05），戒断时间<6个月（P = 0.02），存在精神共病（P < .001），生活伴侣的存在（P < .05），以及高风险酒精中毒复发（HRAR）量表的高分（P < .001）。多因素Logistic回归分析显示，影响复发的独立因素有：戒烟时间<6个月（比值比[ OR]，3.3; 95%置信区间[ CI]，1.2-9.3）（P = 0.02）;存在精神共病（OR，7.8; 95% CI，3.1-20.0）（P < .001）; HRAR评分高于3（OR，10.7; 95% CI，3.8-30.0）（P = .001）。在没有这些因素的患者中，酒精复发率为5%，而存在1、2或3个因素的患者的复发率分别为18%、64%和100%。在一个接受肝移植治疗酒精性肝硬化的大型患者队列中，在等待肝移植前禁欲时间少于6个月，存在精神病合并症，或HRAR评分高于3与有害饮酒复发有关。超过1个因素的存在使这种风险大大增加了50%以上。在这种情况下的LT前评估中，应准确确定这些因素。
Background: Alcohol relapse can negatively influence the outcome after liver transplantation ( LT). The aim of our study was to identify factors that could be associated with the recurrence of harmful alcohol consumption after LT.Methods: A total of 387 consecutive patients ( 23.8% women) who underwent LT for alcoholic cirrhosis in Geneva, Switzerland, and Lyon, France, between 1989 and 2005 were evaluated. Mean +/- SD age was 51.3 +/- 7.5 years. Follow-up time was 61.2 +/- 47.5 months. Alcohol consumption relapse and potential factors associated with it were studied.Results: The relapse rate of harmful alcohol consumption after LT was 11.9%. In univariate analysis, alcohol relapse was significantly associated with age greater than 50 years ( P = .04), year of LT 1995 or earlier ( P < .05), duration of abstinence less than 6 months ( P = .02), presence of psychiatric comorbidities ( P < .001), presence of a life partner ( P < .05), and a high score on the High-Risk Alcoholism Relapse ( HRAR) scale ( P < .001). Multivariate logistic regression disclosed the following independent factors of relapse: duration of abstinence of less than 6 months ( odds ratio [ OR], 3.3; 95% confidence interval [ CI], 1.2-9.3) ( P = .02); presence of psychiatric comorbidities ( OR, 7.8; 95% CI, 3.1-20.0) ( P < .001); and HRAR score higher than 3 ( OR, 10.7; 95% CI, 3.8-30.0) ( P = .001). In patients with none of these factors, alcohol relapse was 5%, while the presence of 1, 2, or 3 factors was associated with relapse rates of 18%, 64%, and 100% of the patients, respectively.Conclusions: In a large cohort of patients undergoing LT for alcoholic cirrhosis, a duration of abstinence of less than 6 months before wait-listing for LT, the presence of psychiatric comorbidities, or an HRAR score higher than 3 was associated with relapse into harmful drinking. The presence of more than 1 factor dramatically increased this risk over 50%. In the pre-LT evaluation in this setting, these factors should be accurately determined.