Alcohol as a risk factor for mortality in liver transplant patients in Sweden

Figures & data

Table 1(a). Patient characteristics: biometrics, diagnoses and smoking before liver transplantation.

	AC (n = 24)	HCC and/or HCV (n = 69)	Others (n = 107)	p-values
Age	58.5 (54.5–63.5)	57.0 (51.0–61.0)	52.0 (39.0–61.0)	0.001
Male n (%)	21 (87.5)	57 (82.6)	65 (60.7)	0.001
Female n (%)	3 (12.5)	12 (17.4)	42 (39.3)	<0.001
Diagnoses
HCV	0	52	1	<0.001
HCC	0	49	0
PSC	0	0	29
Blood groups				0.62
A	14	28	42
B	3	9	18
AB	0	3	6
0	7	29	41
Smoking	10 (43.5)	18 (29.5)	16 (15.4)	0.006

Data are presented as median (interquartile range) for continuous measures and n (%) for categorical measures. AC: alcohol-associated cirrhosis; HCV: hepatitis C virus cirrhosis; HCC: hepatocellular cancer; PSC: primary sclerosing cholangitis.

Figure 1. Flow chart. Legend: Flow chart of patient enrolment and classification by diagnosis. AC: alcohol-associated cirrhosis; HCV: hepatitis C induced liver cirrhosis; HCC: hepatocellular carcinoma. "Other" comprised all other liver diseases except AC, HCV and HCC.

Table 1(b). Patient characteristics: socioeconomic, physical and psychiatric data before liver transplantation.

	AC (n = 24)	HCC and/or HCV (n = 69)	Others (n = 107)	p-values
Family-client 2–4	6 (25.0)	5 (7.2)	14 (13.4)	0.24
Family-interviewer 4–9	7 (29.2)	9 (14.3)	21 (20.5)	0.91
Work-client 2–4	7 (30.0)	13 (23.0)	20 (19.0)	0.09
Work-interviewer 4–9	4 (25)	8 (10.1)	10 (9.3)	0.09
Physical-client 2–4	15 (62.5)	45 (70.3)	75 (72.1)	0.64
Physical-interviewer 4–9	18 (75.0)	44 (68.7)	76 (72.8)	0.71
Psychiatric-client 2–4	6 (25.0)	5 (8.0)	24 (20.9)	0.06
Psychiatric-interviewer 4–9	9 (36.6)	13 (20.6)	35 (33.7)	0.53

Data are presented as n (%) for categorical measures, AC: alcohol-associated cirrhosis; HCV: hepatitis C cirrhosis; HCC: hepatocellular cancer; client: client’s assessment, interviewer: interviewer’s assessment. Participants rate the extent of problems in each area from 0 to 4. Zero equals no problems. Moderate to severe problems are defined as 2–4. The interviewer rates the severity of problems from 0 to 9. Zero equals no problems. Moderate to severe problems are defined as 4–9.

Table 1(c). Patient characteristics: drug and alcohol use before liver transplantation.

	AC n = 24	HCC and/or HCV (n = 69)	Others (n = 107)	p-values
Cannabis ever used	2 (8.3)	27 (39.1)	3 (2.8)	<0.001
Amphetamine ever used	6 (25.0)	36 (56.3)	19 (18.3)	<0.001
Any alcohol last year	6 (26.1)	8 (13.3)	48 (47.1)	<0.001
Lifetime alcohol intake	28030 (6986–8676)	5352 (630–20202)	1053 (198–5056)	<0.001
Lifetime binge	21605 (926–69600)	1218 (0–15680)	4273 (0–960)	<0.001

Data are presented as median (interquartile range) for continuous measures, and n (%) for categorical measures. AC: alcohol-associated cirrhosis; HCV: hepatitis C cirrhosis; HCC: hepatocellular cancer.

Table 2. Mortality, retransplantations and alcohol consumption the first two years after liver transplantation.

	AC n = 24	HCC and/or HCV n = 69	Others n = 107	p-values
Follow-up (patient years)	1897 (1257–2233)	2064 (1627–2229)	2047 (1766–2390)	0.43
Retransplanted	2 (8.3)	4 (5.8)	6 (5.6)
Deceased	4 (16.7)	8 (11.6)	5 (4.7)
Retransplanted or deceased	6 (25)	12 (17.4)	11 (10.3)	0.25
Volume of alcohol (drinks)	120 (0–208)	8 (0–120)	104 (0–225)	0.003
Drinking days	7 (0–47)	5 (0–12)	8 (0–44)	0.02
Volume of binge drinking (≥5 drinks)	19 (0–163)	0 (0–63)	60 (0–166)	0.008
Days with binge drinking (≥5 drinks)	3 (0–7)	0 (0–5)	3 (0–7)	0.017
Abstinence	6 (27.3)	28 (45.2)	29 (27.6)	0.05

Data are presented as median (interquartile ranges) for continuous measures, and n (%) for categorical measures. AC: alcohol-associated cirrhosis; HCV: hepatitis C cirrhosis; HCC: hepatocellular cancer, Follow-up: days from transplantation to retransplantation or death, Retransplanted: number of patients who underwent retransplantation, Deceased: number of patients who died, Binge (≥5 standard drinks): number of drinks consumed as binge after transplantation.

Table 3. The hazard ratio for overall mortality.

	Crude hazard ratio	p-values	Adjusted hazard ratio	p-values
Smoking	0.53 (0.12–2.36)	0.41	0.54 (0.12–2.35)	0.41
Male	1.31 (0.42–4.02)**	0.63	1.32 (0.43–4.10)**	0.62
Age 51–60	0.63 (0.18–2.23)*	0.48	0.64 (0.18–2.23)*	0.48
Age 61–72	1.45 (0.49–4.27)*	0.50	1.45 (0.49–4.30)*	0.49
AC	4.05 (1.07–15.33)	0.04	5.27 (1.10–25.50)	0.04
HCC and/or HCV	2.58 (0.85–7.87)	0.09	3.14 (0.90–10.99)	0.07
LAI	1.00 (0.99–1.00)	0.50	1.00 (0.99–1.00)	0.45
No alc LY	0.91 (0.31–2.71)	0.87	0.84 (0.27–2.58)	0.76
Post-LT alc vol	0.99 (0.99–1.00)	0.62	0.99 (0.99–1.00)	0.60
Post-LT alc days	0.99 (0.99–1.01)	0.35	0.99 (0.96–1.01)	0.48
Post-LT binge vol	0.99 (0.99–1.01)	0.88	0.99 (0.99–1.06)	0.85
Post-LT binge days	0.99 (0.99–1.02)	0.77	1.00 (0.98–1.02)	0.87
Abstinence post-LT	1.97 (0.63–1.11)	0.24	2.03 (0.60–6.85)	0.25

Adjusted Hazard Ratio: adjusted for age and gender, AC: alcohol-associated cirrhosis, HCV: hepatitis C cirrhosis, HCC: hepatocellular cancer, LAI: lifetime alcohol intake, No alc LY: No alcohol last year before liver transplantation, Post-LT: after liver transplantation, alc vol: volume of alcohol consumed, alc days: days drinking alcohol, binge vol: volume alcohol drunk as binge (≥5 standard drinks per day), binge days: days when alcohol are consumed as binge, Abstinence: no alcohol drunk during the full 2 year follow-up period.

*Age is omitted from the adjusted analyses.

**Gender is omitted from the adjusted analyses.

Table 4. The hazard ratio for graft loss.

	Crude hazard ratio	p-values	Adjusted hazard ratio	p-values
Smoking	0.79 (0.30–2.13)	0.65	0.68 (0.26–1.77)	0.42
Male	2.03 (0.79–5.25)	0.14	2.03 (0.78–5.26)**	0.14
Age 51–60	0.70 (0.29–1.65)	0.41	0.70 (0.29–1.65)*	0.41
Age 61–72	0.78 (0.32–1.88)	0.58	0.78 (0.32–1.88)*	0.58
AC	2.70 (1.00–7.30)	0.05	3.24 (1.08–9.77)	0.04
HCC and/or HCV	1.75 (0.77–3.94)	0.18	1.91 (0.77–4.71)	0.16
LAI	1.00 (0.99–1.00)	0.28	1.00 (0.99–1.00)	0.39
No alc LY	1.42 (0.61–3.34)	0.42	1.49 (0.61–3.67)	0.38
Post-LT alc volume	0.98 (0.96–1.00)	0.08	1.00 (0.99–1.00)	0.18
Post-LT alc days	0.98 (0.96–1.00)	0.08	0.98 (0.96–1.00)	0.08
Post-LT binge vol	0.99 (0.98–1.00)	0.34	1.00 (0.99–1.00)	0.34
Post-LT binge days	0.99 (0.95–1.03)	0.64	1.00 (0.96–1.02)	0.58
Abstinence post-LT	2.04 (0.92–4.52)	0.07	2.05 (0.98–4.60)	0.08

Adjusted Hazard Ratio: adjusted for age and gender, AC: alcohol-associated cirrhosis, HCV: hepatitis C cirrhosis, HCC: hepatocellular cancer, LAI: lifetime alcohol intake, No alc LY: no alcohol last year before transplantation, Post-LT: after liver transplantation, alc vol: volume of alcohol consumed, alc days: days drinking alcohol, binge vol: volume alcohol drunk as binge (≥5 standard drinks per day), binge days: days when alcohol are consumed as binge, Abstinence: no alcohol drunk during the full 2 year follow-up period.

*Age is omitted from the adjusted analyses.

**Gender is omitted from the adjusted analyses.

Figure 2. (A) Overall survival is stratified by liver diagnoses. Legend: Overall survival stratified by liver diagnoses as a Kaplan-Meier plot during follow-up. Alcohol-associated cirrhosis, AC (orange), hepatocellular carcinoma, HCC, and/or hepatitis C, HCV (blue) and other diagnoses, Other (green). Log-rank test, p = 0.07. (b) Graft loss is stratified by liver diagnoses. Legend: Graft loss stratified by liver diagnoses as a Kaplan-Meier plot during follow-up. Alcohol-associated cirrhosis, AC (orange), hepatocellular carcinoma, HCC, and/or hepatitis C, HCV (blue) and other diagnoses, Other (green). Log-rank test p = 0.23.

Figure 3. (a) Overall survival stratified by alcohol consumption or no alcohol consumption after liver transplantation. Legend: Overall survival stratified by alcohol consumption after liver transplantation as a Kaplan-Meier plot during follow-up. Abstinence post-LT = yes (orange), any alcohol consumption post-LT = no (green). Log-rank test, p = 0.11. (b) Graft loss is stratified by alcohol consumption or no alcohol consumption after liver transplantation. Legend: Graft loss stratified by alcohol consumption after liver transplantation as a Kaplan-Meier plot during follow-up. Abstinence post-LT = yes (orange), any alcohol consumption post-LT = no (green). Log-rank test, p = 0.07.