Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA.
Division of Transplant Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
Clin Transplant. 2023 Sep;37(9):e15036. doi: 10.1111/ctr.15036. Epub 2023 May 23.
Detection of alcohol (ETOH) use with biomarkers provides an opportunity to intervene and treat patients with alcohol use disorder before and after liver transplant (LT). We describe our center's experience using urine ethyl glucuronide (EtG) and serum phosphatidylethanol (PEth) in alcohol screening protocols.
Single-center, retrospective review of patients presenting for LT evaluation, patients waitlisted for LT for alcohol-associated liver disease (ALD), and patients who received a LT for ALD over a 12-month period, from October 1, 2019 through September 30, 2020. Patients were followed from waitlisting to LT, or for up to 12 months post-LT. We monitored protocol adherence to screening for ETOH use- defined as completion of all possible tests over the follow-up period- at the initial LT visit, while on the LT waitlist and after LT.
During the study period, 227 patients were evaluated for LT (median age 57 years, 58% male, 78% white, 54.2% ALD). Thirty-one patients with ALD were placed on the waitlist, and 38 patients underwent LT for ALD during this time period. Protocolized adherence to screening for alcohol use was higher for PEth for all LT evaluation patients (191 [84.1%] vs. 146 [67%] eligible patients, p < .001), in patients with ALD waitlisted for LT (22 [71%] vs. 14 (48%] eligible patients, p = .04) and after LT for ALD, 20 (33 [86.8%] vs. 20 [52.6%] eligible patients, p < .01). Few patients with a positive test in any group completed chemical dependency treatment.
When screening for ETOH use in pre- and post-LT patients, protocol adherence is higher using PEth compared to EtG. While protocolized biomarker screening can detect recurrent ETOH use in this population, engagement of patients into chemical dependency treatment remains challenging.
使用生物标志物检测酒精（ETOH）的使用为在肝移植（LT）之前和之后干预和治疗酒精使用障碍患者提供了机会。我们描述了我们中心在酒精筛查方案中使用尿液乙基葡萄糖醛酸（EtG）和血清磷脂酰乙醇（PEth）的经验。
对 2019 年 10 月 1 日至 2020 年 9 月 30 日期间在单个中心接受 LT 评估的患者、等待 LT 治疗酒精相关肝病（ALD）的患者和接受 LT 治疗 ALD 的患者进行了回顾性分析。患者从等待名单到 LT 或 LT 后 12 个月进行随访。我们监测了在初次 LT 就诊时、LT 等待名单上以及 LT 后筛查 ETOH 使用的方案依从性-定义为在随访期间完成所有可能的测试-定义为使用 ETOH。
在研究期间，对 227 例接受 LT 评估的患者（中位年龄 57 岁，58%为男性，78%为白人，54.2%为 ALD）进行了评估。31 例 ALD 患者被列入等待名单，在此期间，38 例患者因 ALD 接受 LT。对于所有 LT 评估患者，PEth 筛查酒精使用的方案依从性更高（191 [84.1%] vs. 146 [67%]合格患者，p < 0.001），ALD 等待 LT 的患者（22 [71%] vs. 14 [48%]合格患者，p = 0.04）和 LT 后治疗 ALD 的患者（20 [86.8%] vs. 20 [52.6%]合格患者，p < 0.01）。少数在任何一组中检测呈阳性的患者完成了化学依赖治疗。
在对 LT 前后的患者进行 ETOH 使用筛查时，与 EtG 相比，使用 PEth 可提高方案依从性。虽然方案生物标志物筛查可以检测到该人群中 ETOH 使用的复发，但患者参与化学依赖治疗仍然具有挑战性。
