Is the multidisciplinary support effective in preventing alcohol relapse after liver transplantation?

Introduction: Alcoholic liver disease (ALD) is one of the main indications for liver transplantation (LT) reaching about 30% in Europe and the United States. One of the most important burden in patients transplanted for ALD is alcohol relapse. In fact, according to the literature, the 20–50% of patients experience alcohol relapse in the first 5 years after LT. With this in mind, a program of program of multidisciplinary support to alcohol misuse (MSAM) was started up at the Transplant Unit of University of Rome “Sapienza” in 2004 involving a team of alcohol disorder specialists to help patients undergoing LD for ALD to cope with their alcohol use disorder. Aim: We aimed at analyze the relapse rate, risk factors for relapse and survival in patients involved in MSAM. The relapse rate was also compared with that of a historical group of transplanted patients. Material and methods: Consecutive patients with ALD transplanted from 2004 were included. The most important demographic, psychosocial and clinical characteristics known to be associated with alcohol relapse were registered. Patients transplanted for ALD before from 2000 to 2004, with no access to MSAM, were considered as historical control group. Results: Sixty-nine patients underwent MSAM. 8.7% presented alcohol relapse. Relapse risk factors were female gender (p = 0.004), history of alcohol-withdrawal-syndrome (p = 0.01), a short follow-up before LT (p = 0.004), few sessions for support to alcohol misuse (p = 0.003) and a short time of abstinence before LT (p = 0.0007). The alcohol relapse rate was significantly lower in the MSAM group vs the historical group (8.7% vs 27.7%; p = 0.02) despite similar demographic, clinical and psychological characteristics and a similar transplant follow-up protocol. Five-year survival was higher than that of the historical group (p = 0.008). Conclusion: This study shows that aMSAM program contributes to alcohol relapse prevention after LT in patients transplanted for ALD.