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. 2022 May;36(5):e14595.
doi: 10.1111/ctr.14595. Epub 2022 Jan 27.

Availability of PEth testing is associated with reduced eligibility for liver transplant among patients with alcohol-related liver disease

Ranya Selim  1 , Yueren Zhou  2 , Loralee B Rupp  3 , Sheri Trudeau  2 , Sandra Naffouj  4 , Omar Shamaa  4 , Abdelwahab Ahmed  5 , Syed-Mohammed Jafri  1   5 , Stuart C Gordon  1   5 , Antu Segal  5   6 , Humberto C Gonzalez  1   5
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Availability of PEth testing is associated with reduced eligibility for liver transplant among patients with alcohol-related liver disease

Ranya Selim et al. Clin Transplant. 2022 May.

Abstract

Background: Serum phosphatidylethanol (PEth) is a highly sensitive test to detect alcohol use. We evaluated whether the availability of PEth testing impacted rates of liver transplant evaluation terminations and delistings.

Methods: Medical record data were collected for patients who initiated transplant evaluation due to alcohol-related liver disease in the pre-PEth (2017) or PEth (2019) eras. Inverse probability weighting (IPW) was used to balance baseline patient characteristics. Outcomes included termination of evaluation or delisting due to alcohol use; patients were censored at receipt of transplant; death was considered a competing risk. The Fine-Gray method was performed to determine whether PEth testing affected risk of evaluation termination/ delisting due to alcohol use.

Results: Three hundred and seventy-five patients with alcohol-related indications for transplant (157 in 2017; 210 in 2019) were included. The final IPW-adjusted model for the composite outcome of terminations/delisting due to alcohol use retained two significant variables (P < .05): PEth era and BMI category. Patients evaluated during the PEth era were almost three times more likely to experience an alcohol-related termination/delisting than those in the pre-PEth era (sHR = 2.86; 95%CI 1.67-4.97) CONCLUSION: We found that availability of PEth testing at our institution was associated with a higher rate of exclusion of patients from eligibility for liver transplant. Use of PEth testing has significant potential to inform decisions regarding transplant candidacy for patients with alcohol-related liver disease.

Keywords: PEth; alcoholic liver disease; delisting; evaluation termination; liver transplantation; phosphatidyl ethanol; waitlist outcomes.

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