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Phosphatidylethanol Detects Moderate‐to‐Heavy Alcohol Use in Liver Transplant Recipients

2017; Wiley; Volume: 41; Issue: 4 Linguagem: Inglês

10.1111/acer.13353

1530-0277

Michael F. Fleming, Matthew J. Smith, Erika Oslakovic, Michael R. Lucey, Jenny Vue, Patrice Al‐Saden, Josh Levitsky,

Cannabis and Cannabinoid Research

Background 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 ( PE th) 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. Methods 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. Results Seventy percent (149/213) who reported no alcohol use had consistently negative PE th levels (<8 ng/ml). A total of 26.4% (57/213), 44 alcohol‐dependent patients and 13 controls, had a positive PE th 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 PE th test. Of the 11.2% (24/213) post‐ LT subjects who reported recent alcohol use, over half (11/24) had a positive PE th. The 13 self‐reported alcohol users with a negative PE th level reported insufficient drinking to trigger PE th formation. Conclusions Adoption of PE th 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.