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Background: Phosphatidylethanol (PEth) is a phospholipid formed in the presence of ethanol with a high sensitivity, specificity, and long half-life compared to other alcohol detection tests. PEth has become a key biomarker in liver transplant (LT) evaluation since 2018. We aimed to determine the impact of PEth on the transplant evaluation process and LT waitlist in alcoholic liver disease. Methods: Candidates referred for LT evaluation 1/1/2017 to 11/12/2019 were captured using Organ Transplant Tracking Record at Henry Ford Hospital, Detroit, MI. 2018 evaluations were excluded (testing transition period). Only patients with alcoholic liver disease were included. Patients were divided into pre-PEth (2017) and PEth (2019) eras. Demographics, use of PEth and non-PEth (serum ethanol or urine ethyl glucoronide) testing, Child Pugh/MELD scores, insurance and evaluation termination/delisting reasons were captured. PEth+ was defined as a level >10 ng/dL. Rates of terminations/de-listings were compared between groups using Chi-square. Logistic regression was used to identify factors associated with terminations/de-listings (as a composite outcome). Results: There were 375 evaluations for alcoholic liver disease; 157 in pre-PEth era, 210 in PEth era, and 8 excluded due to loss of follow-up. Patient characteristics are shown in Table 1. There were 72(46%) vs 85(41%) terminations (p=0.321) and 11(7%) vs 2(1%) de-listings in pre-PEth vs PEth eras (p=0.002), respectively. Of the terminations/de-listings, there were 5(7%) due to non-PEth+ in 2017 vs 16(19%) due to PEth+ in 2019 (p=0.069). Odds ratios of terminations/delistings due to alcohol use were 0.36 for black vs white race, 0.43 for employed vs unemployed, 0.52 for Medicare vs Medicaid and 1.37 for commercial insurance vs Medicaid (p=0.069, 0.126, and 0.063 for race, employment status, and insurance, respectively). Conclusion: Our results demonstrate that black race, employment, and commercial or Medicare insurance was associated with lower risk of termination/delisting. There were fewer de-listings in the PEth era. Despite the increased detection of surreptitious alcohol use due to PEth, the rates of termination/delisting for alcohol use were similar. We speculate that our results reflect the use of PEth test as a screening tool prior to transplant referral. Additionally, a recent shift toward a more liberal consideration of a) shorter period of sobriety and/or b) select alcoholic hepatitis patients may explain these findings.





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