*Purpose: Many transplant centers in the United States require six months of abstinence from alcohol prior to liver transplant. Recently, there has been an increased effort to study the validity of the “six-month rule” in determining a patient’s post-transplant alcohol relapse risk. The purpose of this study was to examine a sample of alcohol related liver patient’s pre-operative self-reported sobriety time, and post-operative return to drinking.

*Methods: Data were abstracted as part of a performance improvement project from 67 consecutive patients with alcohol related liver failure, transplanted at an academic medical center in the southeastern United States between April of 2019 and October of 2021. During psychosocial assessment prior to transplant, patients were asked for a self-report of their time since consuming their last alcoholic beverage. Following transplant, serial PEth and EtG were collected as part of the standard of care.

*Results: Mean MELD-NA at time of transplant was 35.1 (SD 6.5). 48 patients (71.6%) have evidenced negative PEth and EtG screening since time of transplant (Mean Days Since Transplant = 378, SD 218). 13 patients (19.4%) tested positive at least once for alcohol since transplant with six of these patients (9%) evidencing multiple positive alcohol tests over time. Chi Square analysis examining differences in post-transplant sobriety between groups reporting abstinence from alcohol greater than, or less than and equal to 45 days did not reveal any significant differences (Pearson Chi-Square = 1.298, p<.255). Of three patients transplanted with greater than six months of reported alcohol abstinence, two have tested positive for alcohol in their post-transplant observation period.

*Conclusions: Patients who tested positive for alcohol have been connected with, and in most cases engaged in, additional addiction treatment services consistent with the performance improvement nature of this project. This study suggests the need to further examine the utility of pre-transplant abstinence time as a predictor of post-operative alcohol recidivism.

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