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 Retrospective analysis was performed on 241 LT recipients with AALD as either a primary or secondary indication for LT (2006‐2015). Results Patients with <6 months of alcohol abstinence had significantly increased cumulative incidence for alcohol relapse compared to those with >6 months of abstinence ( P  = .0041, Log‐Rank). 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.