S-DAT Score Predictive of Alcohol Relapse Risk in Liver Transplant Patients

A new scoring system may help physicians determine a patient’s risk of alcohol relapse following liver transplant for alcohol liver disease.

In new data presented at the American College of Gastroenterology (ACG) 2023 Annual Scientific Meeting in Vancouver, BC this week, a team of investigators from the University of Tennessee showed their Social Determinant Acuity Tool (S-DAT) provided a 96.2% sensitivity, but 40.4% specificity, for the prediction of relapse risk in patients with alcohol liver disease who underwent liver transplant.

The S-DAT is a physician-administered test that which scores components of patients’ social, behavioral, cognitive and socioeconomic statuses on a 0 - 40 scale to interpret risk of alcohol relapse. Investigators led by Jiten P. Kothadia, MD, of the University of Tennessee Health Science Center, sought to evaluate its accuracy in identifying patients with low risk for alcohol relapse at 1 year post-transplant.

Kothadia and colleagues included 140 patients who underwent liver transplant for alcohol liver disease at the institution from January 2016 - November 2021. Patients underwent psychosocial evaluation to interpret pre-transplant alcohol use history and variables of psychosocial health status.

Alcohol relapse following liver transplant was defined as any alcohol use based on patient interviews or blood or urine tests. The S-DAT was administered to each patient and stratified them based on score: 0 - 6 determined excellent candidates, while 35 - 40 determined poor candidates for post-transplant outcomes.

Investigators observed relapses in 26 patients (18.6%), and 33 (23.6%) relapses total. Via multivariate logistic regression analyses, Kothadia and colleagues observed poor S-DAT scores (odds ratio [OR], 1.65; P = .001), alcohol treatment post-transplant (OR, 7.11; P = .02), smoking history (OR, 0.15; P = .03), and marital status (OR, 60.28; P = .001) were each independent risk factors for alcohol relapse in ≤1 year post-liver transplant.

S-DAT itself was associated with an AUROC score of 0.77, for the prediction of one-year relapse risk. For the specific cutoff value of S-DAT scores of ≥12 predicting relapse risk, the test provided 96.2% sensitivity; 40.4% specificity; 26.9% positive predictive value; and 97.9% negative predictive value.

In the first segment of an interview with HCPLive at ACG 2023, Kothadia discussed the advent of S-DAT—a metric borne out of a growing necessity in hepatic disease management.

“This has been outlined by many prospective or multicenter studies that there is still not a magic question that you can ask the patient and identify that this person will not drink,” Kothadia said. “That information is also very multifactorial. So, we know that there are several factors, psychosocial variables, and from that was an initial thought, 'How can we identify this patient to help them to receive the transplant, or identify the patients who are at risk of relapse into a post-transplant intervention?’”

Kothadia additionally discussed the understanding of alcohol relapse risk factors in post-transplant patients with alcohol liver disease prior to this trial; sociodemographic and behavioral traits like younger age, marijuana use, and binge drinking previously helped informed clinicians of potential relapse risk.

Unfortunately, many of the available screening methods are subject to the variability of the patient’s behaviors; their risk of relapse, per these tests, could change by the day or even the hour.

“That's why we thought of developing a tool that is more comprehensive in terms of the patient-related psychosocial variables, but is a little bit more extensive and tries to analyze them. and come up with the tool,” Kothadia said. “The ultimate goal is to prevent the post-transplant relapse and identify a patient at risk so you can prevent them from harmful alcohol use.”

References

^{Kothadia JP, Dash A, Rong J, Liu TY, et al. Predicting Low-Risk for Alcohol Relapse Within One Year Post Liver Transplant for Alcoholic Liver Disease: S-DAT Score. Paper presented at: ACG 2023 Annual Scientific Meeting. Vancouver, BC, Canada. October 20 – 25, 2023.}