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Blood phosphatidylethanol (PEth) positivity associates with unfavorable waitlist-related outcomes for patients medically appropriate for liver transplant.

BACKGROUND
Excessive alcohol use is a leading etiology of liver disease and indication for liver transplantation. Accurate determination of alcohol use remains a challenge in the management of patients in the pre-, peri- and post-liver transplant setting. Blood 16:0-18:1 phosphatidylethanol (PEth) is a sensitive and specific biomarker of binge and moderate, chronic alcohol use. As it has the longest detection window of available blood-based direct alcohol biomarkers for moderate to heavy drinking, it shows promise in indicating patterns and chronicity of drinking. The utility of PEth, however, in clinical liver transplant remains understudied. This study explores the association of PEth results with liver transplant waitlist-focused patient outcomes.


METHODS
Retrospective data for all patients tested for PEth for a one-year period at a tertiary care medical center with an active liver transplantation program were abstracted. Indications for PEth testing, liver transplant waitlist-related outcomes (e.g. listing and delisting) following testing and associations of PEth results with other parameters were analyzed.


RESULTS
Over a one-year period, 153 PEth tests were performed on 109 individuals. The most frequent indications for PEth testing were to objectively determine alcohol use patterns (86.3%) and to diagnostically assess alcohol as a putative etiology of liver injury (13.7%). Of the 109 patients, 56 were medically appropriate for liver transplant. Medically acceptable transplant candidates with unfavorable transplant waitlist-related outcomes (delisting, deferment of transplant evaluation, deferment of listing until completion of recommended alcohol rehabilitation and being deemed not a transplant candidate) were at least 3.41 times more likely to have a positive PEth test than those with favorable transplant waitlist-related outcomes (Odds Ratio 3.41, CI 3.41- ∞, p=0.001).


CONCLUSION
This unicentric study reporting a comprehensive account of PEth utilization at a liver transplant center demonstrates that liver transplant waitlist-related outcomes associate with PEth test results.