Predicting pre-transplant abstinence in patients with alcohol-induced liver disease

Abstract

Background: Some patients with alcohol-induced liver failure will succumb to their disease prior to demonstrating compliance with the six months abstinence rule for liver transplantation. Purpose: The purpose of this study was to determine whether a patient's self-reported, longest period of abstinence predicts subsequent abstinence. Methods: Adult patients (n=63) with alcohol-induced liver disease were asked to recall their longest period of abstinence prior to their initial hepatology visit. Compliance with instructions to remain abstinent was then documented. Results: Nineteen patients (30%) achieved abstinence and 44 (70%) relapsed within six months of seeing their hepatologist. Relapses were more common in patients who self-reported previous periods of abstinence exceeding six months (19/44, 43%) compared with 2/19 (11%) in those with periods of less than six months (p=0.01). Serum albumin levels were lower in relapsers but other tests of liver function (bilirubin level and international ratio of prothrombin time) and predictors of post-transplant recidivism did not associate with relapses. On multivariate analysis, self-reported abstinence (OR: 0.11, 95% CI: 0.02-0.57, p=0.008) and serum albumin levels (regression coefficient 0.113, p=0.02) predicted relapses. Conclusions: A self-reported period of abstinence in excess of six months was associated with an increased risk of subsequent relapse following a hepatologist's instructions to remain abstinent. These counter-intuitive findings should be confirmed by larger, prospective studies.