No abstract

Background Serum phosphatidylethanol (PEth) is a highly sensitive test to detect alcohol use. We evaluated whether the availability of PEth testing impacted rates of liver transplant evaluation terminations and delistings. Methods Medical record data were collected for patients who initiated transplant evaluation due to alcohol‐related liver disease in the pre‐PEth (2017) or PEth (2019) eras. Inverse probability weighting (IPW) was used to balance baseline patient characteristics. Outcomes included termination of evaluation or delisting due to alcohol use; patients were censored at receipt of transplant; death was considered a competing risk. The Fine‐Gray method was performed to determine whether PEth testing affected risk of evaluation termination/ delisting due to alcohol use. Results Three hundred and seventy‐five patients with alcohol‐related indications for transplant (157 in 2017; 210 in 2019) were included. The final IPW‐adjusted model for the composite outcome of terminations/delisting due to alcohol use retained two significant variables (P < .05): PEth era and BMI category. Patients evaluated during the PEth era were almost three times more likely to experience an alcohol‐related termination/delisting than those in the pre‐PEth era (sHR = 2.86; 95%CI 1.67–4.97) Conclusion We found that availability of PEth testing at our institution was associated with a higher rate of exclusion of patients from eligibility for liver transplant. Use of PEth testing has significant potential to inform decisions regarding transplant candidacy for patients with alcohol‐related liver disease.

INTRODUCTION:Alcohol-related liver disease (ALD) is now the leading indication for liver transplantation (LT) in the United States (US). It remains unclear how centers are managing the medical and psychosocial issues associated with these patients.METHODS:We conducted a web-based survey of LT centers in the United States to identify center-level details on peri-LT management of ALD and related issues.RESULTS:Of the 117 adult LT centers, 100 responses (85.5%) were collected, representing all Organ Procurement and Transplantation Network regions. For alcohol-associated cirrhosis, 70.0% of the centers reported no minimum sobriety requirement while 21.0% required 6 months of sobriety. LT for severe alcohol-associated hepatitis was performed at 85.0% of the centers. Monitoring protocols for pre-LT and post-LT alcohol use varied among centers.DISCUSSION:Our findings highlight a change in center attitudes toward LT for ALD, particularly for severe alcohol-associated hepatitis.

No abstract