Background: Cirrhosis of the liver strikes up to 25% of heavy drinkers of alcoholic beverages. Heavy-drinking women appear particularly at risk for developing cirrhosis. Continued drinking and relapse to alcoholism accelerates the process of cirrhosis and its associated medical complications. Liver transplantation is the only cure for alcoholic cirrhosis but its benefits are limited unless relapse to alcoholism can be prevented. The selection of liver transplant candidates with alcoholism is usually limited to those judged most likely to abstain and avoid relapse to alcoholism. This selection process is hampered by poor understanding of the factors associated with alcoholism relapse in patients with cirrhosis. Objective: The objectives of this study include: I.) to determine the predictors of alcoholism relapse in alcoholic cirrhosis, 2.) to examine the role of gender on the clinical presentation and outcome of alcoholism in cirrhosis, 3.) to examine the effect of liver transplantation health service status on alcoholism outcome Methods: One hundred fifty patients with alcoholic cirrhosis choosing abstinence from alcohol as a goal will be interviewed and followed for one year. All subjects will be provided a brief educational intervention to define the beginning of the follow-up period. Relapse to alcohol consumption and to problem drinking will be the primary outcome variables. Outcome measures will be identified using daily diaries, interviews of collateral sources, and review of medical records. Candidate predictor variables will include: high-risk alcoholism relapse risk score, duration of sobriety at interview, cirrhosis severity, psychiatric comorbidity, three models of liver transplant candidate assessment, social support, self-efficacy and liver transplantation health service status (no liver transplantation evaluation, evaluated for transplantation but not accepted, evaluated for transplantation and accepted for transplantation). Cox-proportional hazard modeling will be used to examine the effect of predictor variables on risk and time to relapse. Gender effects on presentation and outcome will be examined. Implications: Better understanding the process of alcoholism outcome in men and women with alcoholic cirrhosis can result in: 1.) improved selection of candidates for transplantation, 2.) development of tertiary prevention and alcoholism treatment strategies.
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