Screening for alcohol-induced liver injury by patient self-report after liver transplantation

Abstract

Despite widespread concern about the magnitude of alcohol consumption and/or recidivism after liver transplantation (LT), no universal agreement exists regarding the tools to assess problem alcohol drinking. We performed a single-center, cross-sectional study to assess the performance of the CAGE questionnaire in discriminating between LT recipients with and without post-transplant alcohol-induced liver injury. A total of 316 adult, consenting, maintenance patients between 6 months and 5 years after LT received the CAGE (Cut down, Annoyed, Guilty, Eye-opener) screening questionnaire. Calculation of the sensitivity, specifi city, receiver operating characteristic (ROC) curve, and likelihood ratio for CAGE scores of 0 to 4 was performed using as gold standard the biopsy-proven evidence of alcohol-induced liver injury (BPAI). One-hundred-ninety-fi ve patients responded to the questionnaire, and among them 45 (23%) had a CAGE score ≥1 (mean 2.13 ± 0.9). Among patients with a CAGE score = 0 there were 11 (7.3%) cases of BPAI, as compared with 24 (53.3%) among patients with a CAGE score of ≥1 (p<0.0001). A CAGE score ≥1 was associated with a sensitivity and a specifi city of 68.5% and 86.8%, and an area under ROC curve of 0.79 (95% CI 0.70-0.87). The likelihood ratios for scores of 0 to 4 were 0.3, 5.2, 7.8, 9.9, and 100, respectively. These ratios were associated with posterior probabilities for BPAI of 7.3%, 53.3%, 63.3%, 87.5%, and 100%, respectively. Based on these data, transplant physicians can improve their ability to predict the probability for alcohol-related liver injury using likelihood ratios for CAGE scores, in the setting of either recurrent or de novo post-transplant alcohol disorder