Alcoholic Cirrhosis is the most common reason for liver failure and the largest diagnostic category receiving liver transplantation. However, factors that shape policy, treatment choices, candidate selection, and public options are strongest against this group. Without guidance from rigorous research data, the future for alcohol cirrhotics pursuing transplantation is uncertain. To date, no studies of outcome in alcoholic cirrhotics have used alcohol research measures or models, as proposed herein. In the transplant literature there is a lack of consistency in relapse definitions, timing or methods of follow-up, or use of post-transplant factors to predict alcohol use. This proposed research will expand the primary aim of alcohol research which is to identify and explain the factors that shape alcohol use and its consequences in various populations. To investigate outcome in alcoholic cirrhotics undergoing liver transplantation, expertise in psychiatry, medicine, transplantation, and alcoholism is needed. The applicant, an M.D. board certified in psychiatry, has the basic requisite skills to embark on this line of research. Through five years of clinical work evaluating, treating, and following alcoholic cirrhotic patients pursuing transplantation the applicant has developed a high degree of clinical acumen as well as the necessary connections to one of the largest liver transplant teams in the U.S. This Mentored Clinical Scientist Development Award will allow the applicant the opportunity to consolidate clinical skills in conjunction with a structured educational program and mentored research. During the award period, the candidate will conduct a prospective longitudinal study of alcohol use following liver transplantation, while investigating pre-transplant and post-transplant factors hypothesized to influence return to drinking. This research experience will be complemented by career development activities supervised by pioneering researchers in addictions, transplantation, and psychiatric research. The proposed plan is designed to develop the candidate's expertise in: 1) longitudinal study design and analysis; 2) alcohol relapse identification and monitoring; 3) conceptual and analytic modeling of relapse factors; and 4) post-transplant alcohol use outcome, and will give her the necessary skills to become an independent academic researcher in addictions and transplantation research.
