Fleming Michael Francis, Smith Matthew J, Oslakovic Erika, Lucey Michael R, Vue Jenny X, Al-Saden Patrice, Levitsky Josh
Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Gastroenterology and Hepatology, University of Wisconsin-Madison, Madison, Wisconsin.
Alcohol Clin Exp Res. 2017 Apr;41(4):857-862. doi: 10.1111/acer.13353. Epub 2017 Mar 20.
Alcohol-dependent liver transplantation (LT) patients who resume alcohol consumption are at risk for a number of alcohol-related problems including liver injury and liver failure. Post-LT patients are strongly advised to remain abstinent. However, we do not know how well this population complies due to a lack of valid methods (self-report and/or biomarkers) to identify alcohol use. Studies suggest as many as 50% resume alcohol use within 5 years. Phosphatidylethanol (PEth) is a new cell-membrane phospholipid biomarker to identify alcohol use in the past 28 days. This prospective study followed 213 LT recipients at 2 U.S. liver transplant centers.
Sample included 213 LT subjects; 70.9% (n = 151/213) had a history of alcohol dependence prior to transplantation and 29.1% (n = 62/213) served as non-alcohol-dependent controls. Subjects participated in face-to-face interviews to assess alcohol use using a 30-day calendar. The protocol called for collecting blood samples at baseline, 6-, and 12-month follow-up.
Seventy percent (149/213) who reported no alcohol use had consistently negative PEth levels (<8 ng/ml). A total of 26.4% (57/213), 44 alcohol-dependent patients and 13 controls, had a positive PEth test of >8 ng/ml either at baseline and/or during the follow-up period. Alcohol-dependent subjects (23.8%; n = 36/151) and 16.1% (n = 10/62) controls reported no alcohol use but had at least 1 positive PEth test. Of the 11.2% (24/213) post-LT subjects who reported recent alcohol use, over half (11/24) had a positive PEth. The 13 self-reported alcohol users with a negative PEth level reported insufficient drinking to trigger PEth formation.
Adoption of PEth as part of routine posttransplant care of LT recipients will enable early identification of patients at risk of alcohol use and facilitate abstinence in patients with a history of alcohol dependence and alcohol-related liver damage.
恢复饮酒的酒精性肝病肝移植（LT）患者面临许多与酒精相关的问题风险，包括肝损伤和肝衰竭。强烈建议LT术后患者戒酒。然而，由于缺乏有效的方法（自我报告和/或生物标志物）来识别酒精使用情况，我们并不清楚这一人群的依从性如何。研究表明，多达50%的患者在5年内恢复饮酒。磷脂酰乙醇（PEth）是一种新的细胞膜磷脂生物标志物，用于识别过去28天内的酒精使用情况。这项前瞻性研究跟踪了美国2个肝移植中心的213名LT受者。
样本包括213名LT受试者；70.9%（n = 151/213）在移植前有酒精依赖史，29.1%（n = 62/213）作为非酒精依赖对照组。受试者参加面对面访谈，使用30天日历评估酒精使用情况。方案要求在基线、6个月和12个月随访时采集血样。
报告无酒精使用的70%（149/213）受试者的PEth水平始终为阴性（<8 ng/ml）。共有26.4%（57/213），即44名酒精依赖患者和13名对照组受试者，在基线和/或随访期间的PEth检测呈阳性，>8 ng/ml。酒精依赖受试者（23.8%；n = 36/151）和16.1%（n = 10/62）的对照组报告无酒精使用，但至少有1次PEth检测呈阳性。在报告近期饮酒的11.2%（24/213）的LT术后受试者中，超过一半（11/24）的PEth呈阳性。13名自我报告饮酒但PEth水平为阴性的受试者报告饮酒量不足，不足以引发PEth形成。
将PEth纳入LT受者移植后常规护理的一部分，将能够早期识别有酒精使用风险的患者，并促进有酒精依赖和酒精相关肝损伤病史的患者戒酒。
