De La Torre Sergio A, Ibrahim Brittney, Meneses Katherine, Saab Sammy, Shetty Akshay
Department of Medicine, University of California at Los Angeles, Los Angeles, California, USA.
Department of Surgery, University of California at Los Angeles, Los Angeles, California, USA.
Alcohol Clin Exp Res (Hoboken). 2024 Dec;48(12):2404-2411. doi: 10.1111/acer.15474. Epub 2024 Oct 31.
Alcohol-related liver disease (ALD) is the leading indication for liver transplantation in the United States. The aim of this study was to describe the impact of phosphatidylethanol (PEth) in the surveillance for alcohol use after liver transplantation.
We conducted a single-center retrospective study to assess the impact of phosphatidylethanol (PEth) for the surveillance of alcohol use and its correlation to health outcomes. We compared orthotopic liver transplant (OLT) recipients for ALD transplanted between 2016 and 2018, before the introduction of PEth, to those transplanted between 2019 and 2022, after the introduction of PEth. Alcohol relapse versus nonrelapse cohorts were also compared. Follow-up time for all cohorts was limited to 3 years post-OLT. Continuous variables were analyzed with an independent t-test and categorical variables with Fischer's exact test and chi-square test. The Kaplan-Meier method and log-rank test were used to assess alcohol-free survival.
We reviewed 263 patients who were transplanted for ALD; 46 (17.5%) patients were noted to have at least one episode of alcohol relapse after their transplant. Patients with alcohol relapse had more frequent episodes of elevated liver enzymes compared with nonrelapsed patients (4.35 episodes vs. 2.46 episodes respectively, p < 0.001). The number of hospitalizations was also noted to be elevated among relapsed versus nonrelapsed patients; however, this was not statistically significant (2.85 vs. 2.50 respectively, p = 0.307). When comparing relapse rates before and after the introduction of PEth, relapses were notably detected more frequently after the introduction of PEth (17% vs. 7%, p = 0.012). No difference was noted in rates of mortality between patients who did or did not relapse.
Overall, PEth is an effective surveillance tool in the postliver transplant population to monitor for alcohol relapse. Early detection of relapse can lead to opportunities for early intervention to avoid alcohol-related complications.
酒精性肝病（ALD）是美国肝移植的主要指征。本研究的目的是描述磷脂酰乙醇（PEth）在肝移植后酒精使用监测中的影响。
我们进行了一项单中心回顾性研究，以评估磷脂酰乙醇（PEth）对酒精使用监测的影响及其与健康结果的相关性。我们将2016年至2018年（PEth引入之前）接受ALD原位肝移植（OLT）的受者与2019年至2022年（PEth引入之后）接受移植的受者进行了比较。还比较了酒精复发病例组与未复发病例组。所有队列的随访时间限制在OLT后3年。连续变量采用独立t检验分析，分类变量采用Fisher精确检验和卡方检验分析。采用Kaplan-Meier方法和对数秩检验评估无酒精生存期。
我们回顾了263例因ALD接受移植的患者；46例（17.5%）患者在移植后至少有一次酒精复发。与未复发患者相比，酒精复发病例的肝酶升高发作更频繁（分别为4.35次发作和2.46次发作，p<0.001）。复发患者与未复发患者的住院次数也有所增加；然而，这在统计学上并不显著（分别为2.85次和2.50次，p=0.307）。比较PEth引入前后的复发率，PEth引入后复发的检测频率明显更高（17%对7%，p=0.012）。复发患者与未复发患者的死亡率没有差异。
总体而言，PEth是肝移植后人群中监测酒精复发的有效监测工具。早期发现复发可为早期干预提供机会，以避免酒精相关并发症。
