Predicting Harmful Alcohol Relapse after Liver Transplant: The HALT Score.

BACKGROUND Alcohol-associated liver disease (AALD) is a rapidly growing indication for liver transplantation (LT). We aimed to examine various clinical, demographic, and behavioral factors to predict post-LT alcohol relapse, and graft survival. METHODS 241 LT patients with AALD (2006-2015) were retrospectively analyzed. RESULTS Patients with 6 months of abstinence (p=0.0041) We identified four variables to predict harmful alcohol relapse post-LT: age at LT, non-alcohol related criminal history, pre -LT abstinence period (Ref>6 months of alcohol abstinence), and drinks per day (Ref<10 drinks/day). Area Under the Curve (AUC) for the final model was 0.79 (95% CI:0.68-0.91). Our multivariable model was evaluated with internal cross-validation; random sampling of the study subjects 100 times yielded a median C statistic of 75 (±SD 0.097) and accuracy of 91 (±SD 0.026). The four-variable model served to form the Harmful Alcohol Use post-LT(HALT) score. Graft survival remained significantly lower in patients with <6 months of pre-LT alcohol abstinence and those with blue-collar jobs. CONCLUSION The HALT score identifies LT candidates with AALD at significant risk for alcohol relapse, potentially guiding transplant centers for pre- and post-LT interventions for improved patient outcomes.