BACKGROUND
Alcohol-associated liver disease remains the leading indication for liver transplant (LT), yet there has been limited analysis of what psychosocial factors correlate with biomarker-confirmed return to alcohol use in the post-LT setting.
MATERIAL AND METHODS
We conducted a single-center, retrospective, cohort study of all adult patients with alcohol-associated liver disease who received a liver transplant (LT) between 2016 and 2022. Medical records were queried for demographics, psychosocial variables, pre-LT sobriety duration, and 1-year post-LT mortality. Logistic regression and time-to-event analysis was used to correlate these factors with post-LT biomarker-confirmed return to alcohol use, defined as at least 1 positive urine ethyl glucuronide, urine ethyl sulfate, or serum phosphatidylethanol.
RESULTS
Of 194 LT recipients, 52 (27% of all patients, 42% of those tested) tested positive for 1 or more alcohol biomarkers at least once. Female sex and younger age, but not pre-LT sobriety duration, were identified as independent risk factors for biomarker-confirmed post-LT return to alcohol use. Survival analysis identified a shorter time to biomarker confirmed return to alcohol use for patients with <6 months (P<0.0001) and 6-12 months (P<0.0001) of pre-LT sobriety, compared with those with ≥12 months sobriety. However, patients with shorter pre-LT sobriety duration underwent biomarker testing significantly earlier following LT (P<0.0001). There was no difference in 1-year post-LT mortality between patients with <6 months and those with > 6-month pre-LT sobriety.
CONCLUSIONS
In this retrospective cohort study, we observed that 1-year mortality and biomarker-confirmed return to alcohol use outcomes were not affected by pre-LT sobriety duration, supporting evolving standards that favor individualized risk assessment over fixed abstinence periods.

Keywords: Alcohol Abstinence; Alcohol Drinking; Alcohol-Related Disorders; Biomarkers; Liver; Mortality; Transplantation