S2632 Factors Related to Alcohol Recidivism Following Liver Transplantation: A Retrospective Study

Introduction: Alcohol recidivism remains a major concern following liver transplantation for alcoholic liver disease (ALD). Identifying predictive factors, including psychiatric history, is critical to guide patient selection and post-transplant care. This study evaluates the relationship between pre-transplant psychiatric illness and post-transplant alcohol use. Methods: We conducted a retrospective review of patients who underwent liver transplantation for ALD between 2020 and 2022 at a single center. Alcohol use post-transplant was assessed using phosphatidylethanol (PEth), with PEth >10 ng/mL considered positive and >100 ng/mL indicating high-risk recidivism. Data collected included psychiatric diagnoses, psychiatric follow-up within 1 and 3 months post-transplant, and demographic variables. Chi-square tests assessed associations between psychiatric variables and recidivism. Results: Of 124 liver transplant recipients, 100 met inclusion criteria (mean age 54.5 ± 9.9 years; 68% man; 92% White). Within 1 year post-transplant, 16% had a positive PEth, and 6% had PEth >100 ng/mL. No significant association was found between recidivism and age, sex, race, or pre-existing psychiatric diagnosis (26% of cohort; P = 0.65). Patients with positive PEth within 6 months were significantly more likely to reach PEth >100 ng/mL by 1 year (P = 0.017). Notably, 63% of recidivists had psychiatric evaluation within 3 months post-transplant (P < 0.001). Conclusion: Pre-transplant psychiatric illness was not predictive of post-transplant alcohol recidivism in ALD patients. However, early post-transplant psychiatric follow-up was associated with higher detection of alcohol use, underscoring the importance of ongoing monitoring and support in this high-risk population.