Early liver transplant for alcohol-associated liver disease: Current state and future directions

Table 4 Psychosocial assessment scores for liver transplant candidacy and risk of alcohol recidivism

Scoring system	Method	Risk factors measured
PACT (1989)	8-item exam; Rated on 5-point scale; Final independent score given to rater's overall impression of candidates' acceptability of a transplant	Knowledge and receptiveness to education; Compliance with medical treatment; Drug and alcohol use; Healthy lifestyle habits and sustainable practices; Risk for psychopathology; Psychopathology, stable personality factors; Family/support system stability
MAPS (1990)	12-item exam; Items vary from yes/no questions and scaled items; Final score assesses risk of alcohol relapse	Acceptance of alcoholism; Prognostic indices; Social stability
PLS (1991)	7-item exam; 3-point scale; Final score examines psychological vulnerability	Past psychiatric history; Quality of family/social support; Prior coping history; Coping with disease/treatment, ability to anticipate problems; Quality of affect; Mental status
TERS (1993)	10-item exam; 3-point scale; Final score indicates functioning level	Prior psychiatric history; Substance abuse; Compliance; Health behaviors; Quality of social support; Prior coping history
HRAR (1993)	3-item exam; Each item stratified into 3 groups of varying severity; Single score given based on risk of alcoholism	Duration of heavy drinking in years; Number of drinks per day; Number of prior alcoholism inpatient hospitalizations
SIPAT (2012)	18-item exam; 4 psychosocial themes evaluated; Varying number of questions for each theme ranging from 3-5 questions; Final score determines risk of candidates for transplantation	Patient's readiness level and illness management; Social support system level of readiness; Psychological stability and psychopathology; Lifestyle and effect of substance use
ARRA (2013)	9-item exam; Final score determines placement into 1 of 4 groups (ARRA I-IV) based on rates of post LT alcohol use	Presence of hepatocellular carcinoma; Tobacco, alcohol dependent; Motivation for alcohol treatment, stress management skills; Rehabilitation, social support status, nonmedical behaviors, amount of alcohol in social activities
HPSS (2017)	11-item exam; 3-point scale; post-hoc analysis of patients with severe alcoholic hepatitis vs alcoholic cirrhosis with > 6 months of abstinence; Final score shows risk of alcohol relapse after transplant	Self-admission to hospital; drinks/day prior to period of abstinence; Insight to diagnosis; Marital status; Abstinence before transplant; Psychiatric comorbidity; History of other substance use; History of failed rehabilitation attempt; Family history of alcoholism; Employment status prior to hospitalization; Alcohol-related legal history
SALT (2018)	Machine learning technique through the multi-center, ACCELERATE-AH cohort; Outcome of interest was sustained alcohol use post LT	Drinks per day at initial hospitalization; Multiple prior rehabilitation attempts; Prior alcohol-related legal issues; Prior illicit substance abuse
HALT (2020)	Retrospective review obtained of liver transplant patients; Final score predicts risk of alcohol relapse after transplant	Age at liver transplant; Non-alcohol related criminal history; Pre-transplant abstinence period; Drinks per day

PACT: Psychosocial Assessment of Candidates for Transplantation; MAPS: Michigan Alcoholism Prognostic Scale; PLS: Psychosocial Levels System; TERS: Transplant Evaluation Rating Scale; HRAR: High-Risk Alcoholism Relapse; SIPAT: Stanford Integrated Psychosocial Assessment for Transplant; ARRA: Alcohol Relapse Risk Assessment; HPSS: Hopkins Psychosocial Scoring System; SALT: Sustained Alcohol Use Post-Liver Transplant; HALT: Harmful Alcohol Post-Transplant score; LT: Liver transplant; ACCELERATE-AH: American Consortium of Early Liver Transplantation for Alcoholic Hepatitis.