Artificial intelligence to identify harmful alcohol use after early liver transplant for alcohol-associated hepatitis

Am J Transplant. 2022 Jul;22(7):1834-1841. doi: 10.1111/ajt.17059. Epub 2022 Apr 25.

Abstract

Early liver transplantation (LT) for alcohol-associated hepatitis (AH) is the fastest growing indication for LT, but prediction of harmful alcohol use post-LT remains limited. Among 10 ACCELERATE-AH centers, we examined psychosocial evaluations from consecutive LT recipients for AH from 2006 to 2017. A multidisciplinary panel used content analysis to develop a maximal list of psychosocial variables. We developed an artificial intelligence model to predict post-LT harmful alcohol use. The cohort included training (N = 91 among 8 centers) and external validation (N = 25 among 2 centers) sets, with median follow-up of 4.4 (IQR 3.0-6.0) years post-LT. In the training set, AUC was 0.930 (95%CI 0.862-0.998) with positive predictive value of 0.891 (95%CI 0.620-1.000), internally validated through fivefold cross-validation. In the external validation set, AUC was 0.692 (95%CI 0.666-0.718) with positive predictive value of 0.82 (95%CI 0.625-1.000). The model identified specific variables related to social support and substance use as highly important to predict post-LT harmful alcohol use. We retrospectively developed and validated a model that identified psychosocial profiles at LT predicting harmful alcohol use post-LT for AH. This preliminary model may inform selection and post-LT management for AH and warrants prospective evaluation in larger studies among all alcohol-associated liver disease being considered for early LT.

Keywords: alcoholism and substance abuse; clinical research/practice; liver transplantation/hepatology; risk assessment/risk stratification.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Alcoholism* / complications
  • Artificial Intelligence
  • Hepatitis, Alcoholic* / complications
  • Hepatitis, Alcoholic* / diagnosis
  • Hepatitis, Alcoholic* / surgery
  • Humans
  • Liver Diseases, Alcoholic* / complications
  • Liver Transplantation* / adverse effects
  • Recurrence
  • Retrospective Studies