Use of a high-risk alcohol relapse scale in evaluating liver transplant candidates

Background: Methods to improve assessment, selection, and monitoring of pat ients with alcoholic cirrhosis who pursue liver transplantation are sought continuously. We chose to investigate the use of the High-Risk Alcohol Rela pse (HRAR) scale in our transplant population in the hope that it would imp rove our ability to identify and follow patients at highest risk for alcoho l relapse. Methods: Detailed alcohol histories of 207 patients evaluated for liver tra nsplantation were collected and graded for severity by using the HRAR. The HRAR provides information on the duration of alcohol use (a measure of chro nicity), daily quantity of alcohol use, and rehabilitation experiences (tre atment responsiveness). Posttransplant alcohol use was monitored through cl inical follow-up in the transplant clinic. Results: Although men and women had similar years of heavy drinking pretran splant, women's daily alcohol consumption was significantly less than men's . HRAR scores did not distinguish those listed for transplant from those no t listed or those who drank posttransplant from those who did not. Transpla nt patients were predominantly in the low-risk group (83% had an HRAR score <4). Conclusions: The HRAR did not have predictive ability in our transplant pop ulation. Few of our patients were rated as high risk, and few drank posttra nsplant. Nevertheless, identifying patients at high risk may improve clinic al care and decrease the rate of posttransplant alcohol consumption.