title: Phosphatidylethanol Detects Moderate-to-Heavy Alcohol Use in Liver Transplant Recipients.
abstract: 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 (PEth) 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.
  
  
  
  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.
  
  
  
  Seventy percent (149/213) who reported no alcohol use had consistently negative PEth levels (<8 ng/ml). A total of 26.4% (57/213), 44 alcohol-dependent patients and 13 controls, had a positive PEth 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 PEth test. Of the 11.2% (24/213) post-LT subjects who reported recent alcohol use, over half (11/24) had a positive PEth. The 13 self-reported alcohol users with a negative PEth level reported insufficient drinking to trigger PEth formation.
  
  
  
  Adoption of PEth 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.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Michael Francis
authors.initials: MF
authors.lastname: Fleming
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Smith
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Erika
authors.initials: E
authors.lastname: Oslakovic
authors.affiliation: Gastroenterology and Hepatology, University of Wisconsin-Madison, Madison, Wisconsin.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Lucey
authors.affiliation: Gastroenterology and Hepatology, University of Wisconsin-Madison, Madison, Wisconsin.
authors.forename: Jenny X
authors.initials: JX
authors.lastname: Vue
authors.affiliation: Transplant Surgery Division (PA-S), Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Patrice
authors.initials: P
authors.lastname: Al-Saden
authors.affiliation: Medicine-Gastroenterology and Hepatology and Surgery-Organ Transplantation, Northwestern University, Chicago, Illinois.
authors.forename: Josh
authors.initials: J
authors.lastname: Levitsky
mesh_terms: D000368:Aged; D000428:Alcohol Drinking / Q000097:blood* / Q000523:psychology* / Q000639:trends; D015415:Biomarkers / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D020404:Glycerophospholipids / Q000097:blood*; D006801:Humans; D016031:Liver Transplantation / Q000523:psychology* / Q000639:trends; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D057566:Self Report; D066027:Transplant Recipients / Q000523:psychology*
chemical_list: D015415:Biomarkers; D020404:Glycerophospholipids; C051521:phosphatidylethanol
keywords: Alcohol Use; Liver Transplant; PEth Biomarker