Implementation of a High-Risk Alcoholism Relapse Scale Post-Liver Transplantation

Abstract

Background: Transplantation will reverse the complications of end-stage liver disease, but it does not treat underlying alcoholism or reduce the risk of relapse after transplant.

Local Problem: In the United States, relapse rates are 20-50% among liver transplant recipients. Relapse after transplant has been identified as a problem among liver transplant recipients at a large urban academic transplant center. The purpose of this quality improvement project was to implement and evaluate the effectiveness of a High-Risk Alcoholism Relapse scale to screen and identify patients at high-risk for alcohol relapse post-transplant.

Interventions: The scale was used to screen new adult liver transplant recipients prior to hospital discharge. The scale is a predictive tool designed to determine severity of alcoholism and risk of relapse after transplantation. The scale consists of three variables identified as having the highest predictive power for early relapse, including daily number of drinks, history of previous inpatient treatment for alcoholism, and the number of years of heavy drinking.

Results: Descriptive statistics revealed 33 patients were screened with the scale. Forty percent of patients (n=13) were identified as being a high-risk for relapse and 60% low-risk (n=20). Fiftyfour percent reported drinking nine to 17 drinks per day, and zero patients consumed fewer than nine drinks per day. Fifty-four percent reported drinking more than 25 years. One third of highrisk patients received inpatient treatment for alcoholism at least once.

Conclusions: Early identification and close monitoring of alcohol relapse is an essential determinant of long-term outcomes after liver transplantation. Findings validate the effectiveness of the scale to screen and identify patients at high-risk for post-transplant relapse. Results support the scale as a more efficient method to identify heavy alcohol use than other screening methods. Recommendations for future studies include performing a follow-up study to compare HRAR results with relapse rates, and modifying the scale to appropriately capture and identify young adults at high-risk for relapse after transplant. Recommendations to help maintain post-transplant sobriety include starting a transplant support group within the organization for all high-risk patients.