Predicting Low-Risk for Alcohol Relapse Within 1 Year Post Liver Transplant for Alcoholic Liver Disease: S-DAT Score

Introduction: Liver transplant (LT) for alcoholic liver disease (ALD) requires careful evaluation of the patients at risk for recidivism. We sought to evaluate the accuracy of the Social Determinant Acuity Tool (S-DAT) to identify patients with low risk for alcohol relapse within 1 year post-LT. Methods: One Hundred forty patients who underwent LT for ALD in our institution from January 2016 to November 2021 were included in the study. All patients underwent a thorough psychosocial evaluation to obtain detailed pre-transplant alcohol use history and psychosocial variables. Post-LT alcohol relapse was defined as any alcohol use regardless of the amount or frequency. It was determined based on patient interviews or blood/urine tests (alcohol level, ethyl glucuronide, and/or phosphatidylethanol test). The Social Determinant Acuity Tool (S-DAT) was used to stratify patients from excellent (Score: 0-6) to poor candidates (score: 35-40) for post-LT outcomes. Results: The alcohol relapse rate at 1-year post-LT was 26 (18.6%), and the overall relapse rate was 33 (23.6%). Multivariate logistic regression analysis revealed S-DAT score (Odds Ratio [OR], 1.65; P=0.000), alcohol treatment post-LT (OR, 7.11; P=0.02), smoking history (OR, 0.15; P= 0.03) and marital status (OR, 60.28, P=0.000) were independent risk factors associated with post-LT alcohol relapse within 1 year (Table 1). The areas under the receiver operative curves (AUROC) of the S-DAT score to predict alcohol relapse within 1 year Post LT was 0.77 (Figure 1). For specific cut-off value, the S-DAT score (≥12), for predicting relapse risk, has 96.2%% sensitivity, 40.4% specificity, 26.9% positive predictive value, and 97.9% negative predictive value. Conclusion: 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-LT.Figure 1.: Accuracy of S-DAT Score in Predicting Alcohol Relapse within 1-Year Post LT. Table 1. - Multivariate Logistic Regression Analysis of Risk Factors for Alcohol Relapse within 1-Year Post LT Odds Ratio Std. Err 95% CI P Value Gender 1.03 0.79 0.23 - 4.60 0.97 Age at LT 0.98 0.035 0.91- 1.049 0.54 BMI at LT 0.96 0.06 0.86 -1.077 0.50 Working for Income at LT 1.68 1.36 0.34 - 8.25 0.52 S-DAT Score before LT 1.65 0.23 1.26 - 2.16 0.000 Alcohol Treatment Pre-LT 1.46 1.04 0.36 - 5.89 0.59 Alcohol Treatment Post-LT 7.11 6.32 1.24 - 40.58 0.02 AbsteinencePreLT6M 0.89 0.64 0.22 - 3.64 0.87 Psychiatric History Depression 0.31 0.46 0.02 - 5.692 0.43 Anxiety 1.34 2.02 0.07 - 25.69 0.85 Bipolar Disorder 11.21 17.13 0.56 - 223.90 0.11 Smoking History 0.16 0.13 0.03 - 0.84 0.03 Marital Status 60.28 68.44 6.51 - 557.89 0.000