Crystal Phend, Senior Staff Writer, MedPage Today Published: August 19, 2010
Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston.
Problem drinking after liver transplantation for alcoholic liver disease can be predicted by looking at just a few factors, a prospective study showed.
Return to alcohol use was predicted by a shorter length of sobriety before transplantation, a positive family history of alcoholism, and a diagnosis of alcohol dependence, Andrea DiMartini, MD, of the University of Pittsburgh Medical Center in Pittsburgh, and colleagues found.
Fully 46% of those in the cohort study started drinking again at some point, with moderate to heavy consumption in 42% of those, the researchers reported online in the American Journal of Transplantation.
The predictors may allow physicians to target their preventive and interventional treatment resources to at-risk individuals at the right time, DiMartini's group suggested.
The study included detailed prospectively-collected data on alcohol consumption from 208 patients who had a liver transplant for a primary or secondary diagnosis of alcoholic liver disease (78% of all such cases treated) at a single center over a six-year period.
Patients were counseled at every follow-up office visit to abstain completely from alcohol. Those who reported drinking got further counseling from the transplant psychiatrist and referral for professional alcohol counseling as needed.
Although therefore not a natural history study, this standard of care is followed at most transplant programs, the researchers noted.
Several patterns emerged for return to alcohol use among the 95 patients who didn't stay on the wagon:
•55 drank low amounts infrequently
•13 started drinking moderate amounts right away but cut down over time
•15 resumed moderate drinking later on and increased the amount over time
•12 immediately started drinking heavy amounts and increased the amount over time
This suggested that problem drinking may not start right away and thus "clinical monitoring should extend well beyond the early years post-liver transplantation," the researchers recommended in the paper.
Early moderate to heavy drinking patterns were predicted by:
•Poorer health after transplantation than in the year prior
•More bodily pain
•More fatigue
•More perceived stress
•A pretransplantation history of other substance use
•Not feeling confident that they would get another liver if needed
One explanation may be that patients felt ineffectual, feeling worse and not sure anything could make it better, the researchers suggested.
Or, alcohol use may have been how they handled stress, including the difficulties of the early post-liver transplantation phase, they added.
"Early identification and treatment of stress especially as it relates to early post-liver transplantation recovery, attention to complaints of pain and fatigue, as well as resumption of addiction counseling may aid in the stabilization of these patients," DiMartini's group wrote in the paper.
By contrast, those who drank minimally and consistently in the early period after transplantation reported better health and more vitality afterward, were less stressed, less likely to be in pain, did not regret their decision, and felt more confident they would get another liver if needed.
A possible explanation for their return to drinking could have been complacency about their overall health and the health of their liver leading to the feeling that occasional drinking early on would not be a problem, the researchers speculated.
They cautioned that the study was limited by the small size of the different trajectory groups and that participation in the study may have affected behavior of those in it.
The authors also noted that they had just begun to collect outcome data, which will be the subject of a later report.
The study was funded by grants from the National Institute of Alcohol Abuse and Alcoholism and the National Institute of Digestive Disorders and Kidney Diseases.
The researchers reported having no conflicts of interest to disclose.
Primary source: American Journal of Transplantation
Source reference:
DiMartini A, et al "Trajectories of alcohol consumption following liver transplantation" Am J Transplant 2010; 10.
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