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Indexed/Abstracted in: CAB, EMBASE, PubMed/MEDLINE, Scopus, Emerging Sources Citation Index
Online ISSN 1827-1642
De Simone P. 1, De Geest S. 2, 3, Ducci J. 1, Carrai P. 1, Petruccelli S. 1, Baldoni L. 1, Pollina L. 4, Campani D. 4, Filipponi F. 1
1 General Surgery and Liver Transplantation Unit, Department of Liver Transplantation, Hepatology, and Infectious Disease, University of Pisa Medical School Hospital, Pisa, Italy;
2 Institute of Nursing Science, Faculty of Medicine, University of Basel, Basel, Switzerland;
3 Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Leuven, Belgium;
4 Department of Pathology, University of Pisa Medical School Hospital, Pisa, Italy
AIM: This was a single-center, mixed-design, cross-sectional and retrospective study to assess the performance of the 4-item, self-reported CAGE (Cut down, Annoyed, Guilty, Eye-opener) questionnaire in predicting histology-proven alcohol-related liver graft injury (ARLGI).
METHODS: A total of 316 liver transplant (LT) patients between six months and five years were enrolled. Based on previous research, problem alcohol drinking (PAD) was defined as any score ≥1 on the CAGE, while a cut-off of 2 was assumed for alcohol dependence (AD).
RESULTS:Responders were 195, 45 (23.1%) had a CAGE score ≥1 and 30 (15.3%) scored ≥2. After controlling for confounders, PAD was associated with hyperlipidemia (P=0.01), while AD with a male gender (P=0.01), hyperlipidemia (P=0.03) and alcohol as native diagnosis (P=0.03). PAD and AD were both associated with a significantly higher prevalence of ARLGI, i.e. 53.3% and 63.3%, respectively (P<0.0001). Hepatitis C virus (HCV) patients with PAD showed more steatosis (P=0.04), portal infiltrate (P=0.03), and pericellular/perivenular fibrosis (P=0.02). The likelihood ratios for CAGE scores ranging from 0 to 4 in predicting ARLGI were 0, 5.2, 7.8, 7.8, and 100, respectively.
CONCLUSION: By use of a self-report instrument we found a 23.1% prevalence of PAD and a 15.3% prevalence of AD among LT patients between six months and five years. A variable degree of ARLGI was present in 53.3% of PAD and 63.3% of AD, respectively. HCV patients with PAD had more steatosis, portal inflammation, and pericellular fibrosis. Transplant physicians might improve their ability to predict the probability for ARLGI using the CAGE.