Management of alcohol use disorder in patients with cirrhosis in the setting of liver transplantation

Patient‐ and provider‐level factors that underlie alcohol use disorder treatment offer and acceptance in veterans with cirrhosis

“…Patients with cirrhosis and AUD have an increased urgency of treatment compared to people without liver disease (Arab et al, 2021). While AUD is a chronic disease process that exists on a spectrum of severity any amount of alcohol is unsafe for people with liver disease (Grant et al, 2017; Tapper & Parikh, 2018).…”

The Role of Psychosocial Screening Tools in the Evaluation of Transplantation Patients With Alcohol‐Related Liver Disease

“…Although randomized controlled trials evaluating the safety and effectiveness of medications to treat alcohol or substance use disorders have not been published in patients with ALD, there are convincing data about the safety and effectiveness of certain anticraving medications in the non-ALD population that can be applicable to patients with ALD. (6) In addition to treatment, monitoring for abstinence with random biochemical screening (eg, phosphatidylethanol and urine toxicology) should be conducted prior to and following transplant. Screening for other mental health symptoms using standardized screening tools may also be warranted for those at risk of other mental health disorders.…”

“…Although randomized controlled trials evaluating the safety and effectiveness of medications to treat alcohol or substance use disorders have not been published in patients with ALD, there are convincing data about the safety and effectiveness of certain anticraving medications in the non‐ALD population that can be applicable to patients with ALD. ( 6 )…”

Blood phosphatidylethanol testing and liver transplant eligibility selection: A step closer

“…These include liver transaminases such as aspartate aminotransferase or AST and alanine aminotransferase or ALT, gamma‐glutamyl transferase, mean corpuscular volume, and carbohydrate‐deficient transferrin. Although these measures are simple, widely available, and can be informative for months, their clinical utility is limited by their low sensitivity and specificity (Arab et al, 2022; Merli et al, 2019). Direct biomarkers are measurable byproducts of alcohol metabolism.…”

“…Of these tools, the AUDIT, which captures and quantifies alcohol use within the last year, is the most commonly used. However, it has a sensitivity of 64% to 86% and a specificity of 74% to 94% (Singal, 2021a), which are limited by ALD patients providing potentially inaccurate information on alcohol use due to memory issues from hepatic encephalopathy, perception of social stigma, and fear of being denied listing for transplant (Arab et al, 2022;Mathurin & Lucey, 2020).…”