Utility of peth testing in liver transplant evaluation: Examining the accuracy of selfreported alcohol use

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Conference Proceeding

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Background: In the liver transplant (LT) evaluation phase, it is important to identify patients who are actively using alcohol; however, it is unclear whether self-report of alcohol use is reliable. Phosphatidyl ethanol (PEth) is formed in the presence of ethanol in cell membranes of red blood cells and is a specific and sensitive marker for detection of recent alcohol intake (i.e., previous 2 to 4 weeks); however, utility of PEth testing during the LT evaluation has not yet been evaluated. The purpose of the study was to investigate the utility of using PEth beyond self-reported alcohol use during pre-surgical evaluations for LT candidates. Methods: Retrospective chart reviews were conducted for 154 patients undergoing routine pre-surgical psychological evaluations prior to LT listing from January 2020 to December 2020. Data extracted included results from PEth testing, and self-reported recent alcohol use (i.e., within the previous month) from the psychological evaluation. Results: Of the 154 patients, 71.4% (n= 110) had a PEth test. Of the 110 patients, 71.4% who completed a PEth test, 25.5% (n= 28) had a positive result (range= 11-2000). Among those with a positive PEth test, the majority denied recent alcohol use in the psychological evaluation (64.3%; 18/28). There were 24.7% (n= 38) patients who had repeat PEth testing. Of those patients, 63.2% (n= 24) had negative PEth tests on both screens, 18.4% (n= 7) had a positive initial screen followed by a negative second screen; and 18.4% (n= 7) were positive on both screens. No patients with a negative initial PEth test had a positive screen on the second test. Having a positive PEth test was not related to whether a patient was listed for LT (X2 = .42, p = .52), or whether a patient received a LT (X2 = .04, p = .85). Conclusion: PEth testing was effective in revealing surreptitious alcohol use in patients being evaluated for LT. Findings suggest that there is utility beyond self-report of using objective measures, such as PEth. This information could be used by clinicians to guide individualized treatment for patients with alcohol misuse to optimize health. Treating alcohol misuse pre-LT has been shown to reduce post-LT alcohol relapse and lower mortality. In addition, there may not be benefits for repeat PEth testing prior to LT for those who had an initial negative test unless there is concern for relapse.

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Not assigned.





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