# Project 2-Optimization of Post-Transplant care via Biomarkers and Behavioral Interventions

> **NIH NIH P50** · JOHNS HOPKINS UNIVERSITY · 2020 · $486,389

## Abstract

In the United States, alcoholic liver disease (ALD) is the second most common indication for liver
transplant (LT). Traditionally, ALD patients have been required to complete a six-month mandatory period of
alcohol abstinence before LT. More recently early LT for severe alcoholic hepatitis is being performed without
any pre-transplant alcohol treatment because of the high medical acuity and mortality associated with this
disease. Importantly, the limited studies to-date demonstrate comparable survival among early (ELT) versus
standard (SLT) transplant recipients. Return to alcohol use is a major concern for all LT recipients with ALD,
with estimates of alcohol relapse ranging between 16 and 49%. Although most LT clinics have enforced pre-LT
alcohol treatment, far less attention has been paid to post-LT services, despite the high risk and severe
consequences of relapse during this period. Numerous evidence-based treatments are available for alcohol
use disorder (AUD). In recent years, our group and others have developed web- and text-based versions of
these empirically-supported interventions to expand their reach and replicability outside of formal alcohol clinic
settings. Delivery of AUD interventions in non-traditional settings is feasible, acceptable to patients, and
effective in reducing alcohol use. We propose to implement and evaluate the effects of alcohol treatment
integrated into routine post-LT care. All patients receive physician instructions to stop drinking and engage in
alcohol services (treatment as usual: TAU). ELT (N=100) and SLT (N=100) patients will be randomized on a
2:1 basis to integrated AUD treatment (IAT) or TAU. IAT will include computer-delivered BI in the hospital,
nurse-delivered alcohol monitoring counseling at each outpatient LT follow-up visit, and at-home participation
in web-based, 7-session CBT4CBT, supplemented by tailored text messages. Also, because of the evidence
that ALD patients significantly underreport their drinking to LT providers, we will compare post-LT alcohol
relapse rates using a well-validated biomarker of recent drinking (PEth), patient self-report on a validated
alcohol instrument, and patient report to their LT provider. Finally, we will identify predictors of post-LT alcohol
use and treatment engagement for ELT and SLT patients. Key measures will include: alcohol use;
engagement in alcohol treatment; retention in post-transplant follow-up care; mood and anxiety; and quality of
life. Given the severe consequences of alcohol relapse among both ELT and SLT recipients, it is critical to
accurately identify alcohol use and implement alcohol interventions early in the post-transplant period to
optimize short- and long-term patient outcomes and ultimately tailor treatments for this high-risk population.

## Key facts

- **NIH application ID:** 9852406
- **Project number:** 5P50AA027054-02
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** MARY E MCCAUL
- **Activity code:** P50 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $486,389
- **Award type:** 5
- **Project period:** — → —

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9852406

## Citation

> US National Institutes of Health, RePORTER application 9852406, Project 2-Optimization of Post-Transplant care via Biomarkers and Behavioral Interventions (5P50AA027054-02). Retrieved via AI Analytics 2026-05-21 from https://api.ai-analytics.org/grant/nih/9852406. Licensed CC0.

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