Depressive and anxiety symptoms mediate the relationship between family support and alcohol relapse in transplant recipients with alcohol-associated liver disease

Alcohol-associated liver disease (ALD) is a leading indication for liver transplantation (LT) worldwide, including Korea, where living donor LT from family members are common. Perceived family support may influence resilience in alcohol consumption, with depressive and anxiety symptoms potentially shaping this relationship. This cross-sectional multicenter study examined whether these psychological symptoms mediate the relationship between perceived family support and risk of alcohol relapse. We recruited 154 LT recipients from two tertiary hospitals in Seoul, Korea, using self-report questionnaires and electronic medical records. Mediation analysis was performed using the PROCESS macro with 5,000 bootstrapped samples. Participants reported moderate to high perceived family support, with depressive and anxiety symptoms varying by sex and socioeconomic status. Higher levels of perceived family support were associated with lower risk of alcohol relapse (direct effect β = - 0.115, p < .05). Depressive and anxiety symptoms were significant mediators in the relationship between family support and alcohol relapse (total effect β = - 0.374, p < .001). Perceived family support plays a role in mitigating post-transplant alcohol relapse, both directly and indirectly through psychological symptoms. Future interventions should integrate family support and psychological care to prevent and manage alcohol consumption in LT recipients with ALD.