PREDICTION OF ABSTINENCE FROM ETHANOL IN ALCOHOLIC RECIPIENTS FOLLOWING LIVER-TRANSPLANTATION

The prediction of abstinence horn ethanol may be crucial to the optima l selection of liver transplantation candidates with alcoholism. Of 84 consecutive end stage alcoholic patients who underwent transplantatio n (1986-1994) at our institution, we analyzed 63 long-surviving recipi ents for pretransplantation variables to predict posttransplantation a bstinence (follow-up: 49.3 +/- 21 mo). Thirty-three pretransplantation variables were reviewed from our transplantation data base and supple mented and confirmed with interviews with recipients. The psyche-socia l inclusion criteria included the following: patient recognition of al coholism, a domicile, an occupation, and at least one close personal r elationship. The incidence of abstinence from ethanol was (50/63) 79%. A logistic regression of the 33 variables in conjunction with our abo ve inclusion criteria accurately predicted abstinence (90% accuracy, c hi(2) model, P < .00001) based on the absence of previous history of a ny illicit drug use (Drug Use: yes = 1/no = 0), the presence of an act ive, personal life insurance policy (Life Ins: yes = line = 0), number of alcoholic sisters (ETOH-SIS), and the length of pretransplantation abstinence (PRE-TRANS-ABS, mos): Prob. of abstinence = 1/1 + e(-F), F = -0.33 + 0.89 (DRUG USE) -1.02 (LIFE INS) -1.68 (ETOH-SIS) +0.24 (PR E-TRANS-ABS). In contrast, receiver-operating characteristic curve ana lysis found that 7 and 9 months of pretransplantation abstinence were the best cut-off points in predicting subsequent abstinence, but poor utility was noted at these points with this specific value alone (sens itivity 61-84%, specificity 64-68%). A separate analysis of high-risk patients with poly-drug use (n = 15, alcohol recidivism 8/15, 53%) and the remaining low-risk group of purely alcohol dependent patients (n = 48, alcohol recidivism 5/48, 10%) found no combination of variables was predictive of abstinence in either group, The length of pretranspl antation abstinence is a relatively poor predictor of posttransplantat ion abstinence. Variables of comorbid substance use, social function, and possibly family history are more predictive in conjunction with ou r standard criteria and might be useful as tools in evaluating liver t ransplantation candidates whose primary diagnosis is alcohol-induced c irrhosis.