RISK of alcoholic relapse following liver transplant for alcohol-related liver disease may be more accurately determined with the help of a new scoring system. New data presented at the American College of Gastroenterology (ACG) 2023 Annual Scientific Meeting in Vancouver, Canada, by a research team based at the University of Tennessee, Knoxville, USA, suggest that their Social Determinant Acuity Tool (S-DAT) provides a 96.2% sensitivity, but 40.4% specificity when predicting relapse in patients with alcohol-related liver disease who underwent transplant.
The S-DAT scores components of a patient’s social, behavioural, cognitive, and socioeconomic statuses on a scale of 0–40, resulting in a prediction of alcoholic relapse. The research team sought to evaluate its accuracy in identifying patients with low risk of alcoholic relapse at 1 year post-transplant.
Overall, 140 patients were included in the study, all of whom underwent liver transplant for alcohol-related liver disease between January 2016–November 2021. Psychosocial evaluation assessed pre-transplant alcohol use and variables of psychosocial health status. Alcoholic relapse following liver transplant was defined as any alcohol use, ascertained through patient interviews, blood tests, or urine tests. The S-DAT was then administered to each patient, permitting the stratification of the study population based on their score, with 0–6 being ‘excellent candidates’ and 35–40 being ‘poor candidates’ for post-transplant outcomes.
Relapse was observed in 26 patients (18.6%) after 1 year, with a total of 33 (23.6%) relapses during the study period. Multivariate logistic regression analyses suggested that poor S-DAT scores, alcohol treatment post-transplant, smoking history, and marital status were each independent risk factors associated with alcohol relapse within 1 year of liver transplant. Considering the accuracy of S-DAT in predicting 1-year relapse, the test was associated with an area under the receiver operative curve of 0.77. When using a specific cut-off value of ≥12 for the prediction of relapse, the test provided 96.2% sensitivity, 40.4% specificity, 26.9% positive predictive value, and 97.9% negative predictive value.
The researchers concluded: “The S-DAT score’s high sensitivity and negative predictive values make it a good screening tool for identifying patients at low risk of alcohol relapse post-liver transplant,” and “the ultimate goal is to prevent the post-transplant relapse and identify a patient at risk so you can prevent them from harmful alcohol use.”
