Utility of phosphatidylethanol testing in liver transplant evaluation: examining concordance to self-reported alcohol use

Segal, Antú; Adkins, Elise; Fatabhoy, Megha; Bryce, Kelly; González, Humberto C.; Miller-Matero, Lisa R

doi:10.1097/lvt.0000000000000097

Cited by 9 publications

(13 citation statements)

References 8 publications

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“…Less common are PEth-negative patients who report recent drinking. [5,10] Such disclosure may represent a patient's favorable capacity to report all drinking; PEth was simply undetectable at lab draw. Such discordance can also arise from unreliable collateral sources (family and medical records) or inaccurate patient report caused by altered mental status or intention to receive benzodiazepines under the guise of impending alcohol withdrawal.…”

Section: Scenarios Of Peth Concordance and Discordancementioning

confidence: 99%

“…Less common are PEth-negative patients who report recent drinking 5,10 . Such disclosure may represent a patient’s favorable capacity to report all drinking; PEth was simply undetectable at lab draw.…”

Section: Scenarios Of Peth Concordance and Discordancementioning

confidence: 99%

“…Recent single-center data indicate high clinician PEth use (74%), positivity (22%; 10 -2000 ng/mL), and discordant positive results (56%) reaching statistical significance (χ 2 = 28.1, p < 0.001). [5] Discordance may contribute to unfavorable waitlist outcomes known to affect otherwise medically appropriate PEth-positive LT candidates. [9,22] Despite its high utility and recommended use, [23,24] little guidance exists regarding the application of PEth results to clinical care in LT.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3] Yet patient disclosure of substance use is unreliable. [4][5][6][7] This means biomarkers are crucial detection tools regarding diagnosis, organ allocation, and post-LT treatment. Using assays with detection windows of approximately 3-5 days [ie, urinary immunoassay and urinary ethyl glucuronide (uEtG)], 20% of alcohol-associated liver disease (ALD) patients were positive for alcohol use and 40% of patients with HCV were positive for drug use while only 3% and 5% reported use, respectively.…”

Section: Introductionmentioning

confidence: 99%

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“But I didn’t drink!”: What to do with discordant phosphatidylethanol results

Winder

Clifton

Denysenko

et al. 2023

Liver Transplantation

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Liver transplantation (LT) teams must be adept at detecting, evaluating, and treating patients’ alcohol use given its prominence among psychological and behavioral phenomena which cause and contribute to liver diseases. Phosphatidylethanol (PEth) is a highly useful alcohol biomarker increasingly recommended for routine use in hepatology and LT. PEth is unique among alcohol biomarkers because of its wide detection window, high sensitivity and specificity, and the correlation of its numerical value with different patterns of alcohol use. Alongside myriad clinical opportunities in hepatology and LT, PEth also confers numerous challenges: little guidance exists about its clinical use; fearing loss of LT access and the reactions of their clinicians and families, candidates and recipients are incentivized to conceal their alcohol use; and liver clinicians report lack of expertise diagnosing and treating substance-related challenges. Discordance between patient self-reported alcohol use and toxicology is yet another common and particularly difficult circumstance. This article discusses the general toxicological properties of PEth; explores possible scenarios of concordance and discordance among PEth results, patient history, and self-reported drinking; and provides detailed clinical communication strategies to explore discordance with liver patients, a key aspect of its use.

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Section: Scenarios Of Peth Concordance and Discordancementioning

confidence: 99%

Section: Scenarios Of Peth Concordance and Discordancementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

“But I didn’t drink!”: What to do with discordant phosphatidylethanol results

Winder

Clifton

Denysenko

et al. 2023

Liver Transplantation

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“…The purpose of this study was to investigate whether there are demographic or psychosocial factors assessed during the pre‐surgical transplant evaluation that are associated with a positive PEth test. PEth testing can help identify patients who are currently using alcohol who are not self‐reporting, 8 so it is not clear whether factors associated with self‐reported alcohol use would be the same as factors associated with an objective measure of alcohol use. We hypothesize that there will be certain factors associated with a positive PEth test (i.e., psychiatric comorbidities, level of education, marital status) given that these factors are associated with alcohol use in the general population.…”

Section: Introductionmentioning

confidence: 99%

Factors associated with a positive phosphatidylethanol test during liver transplantation evaluation

Segal

Pearl

Fatabhoy

et al. 2023

Clinical Transplantation

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BackgroundEarly identification of alcohol use is crucial for informing recommendations of appropriate follow‐up treatment pre‐liver transplant and optimizing post‐liver transplant outcomes. The purpose of the study was to investigate whether there are psychosocial factors associated with a positive PEth test.MethodsAll patients who underwent a routine pre‐surgical psychological evaluation for liver transplant listing (all etiologies, including acute liver failure, dual organ, and re‐transplantation) at a single health care system in 2020 were included in a retrospective chart review. Data extraction included results from PEth testing and information from the psychological evaluation (i.e., demographic, psychiatric symptoms, and cognitive functioning).ResultsThere were 158 patients (73.8%) who had a PEth test, of whom 21.5% had a positive result (n = 34). Younger age was associated with a positive PEth (p < .001). ALD status and type of ALD (hepatitis vs. cirrhosis) were also associated with a positive PEth test. Other demographic characteristics and psychiatric symptoms were not associated with a positive PEth result (p > .05).ConclusionYounger age was the only significant demographic variable associated with a positive PEth test. Given the difficulty of predicting who may be using alcohol, it may be useful to use PEth testing for all patients during the pre‐liver transplant evaluation and while patients are listed for liver transplant. Early identification of alcohol use through routine PEth testing will help identify patients who are using alcohol and need further treatment for alcohol use to optimize health and post‐transplant outcomes.

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