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Selim R, Zhou Y, Rupp LB, Trudeau S, Naffouj S, AlShamaa O, Ahmed A, Jafri SM, Gordon SC, Segal A, Gonzalez HC. Availability of PEth testing is associated with reduced eligibility for liver transplant among patients with alcohol-related liver disease. Clin Transplant 2022; 36:e14595. [PMID: 35041223 DOI: 10.1111/ctr.14595] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 12/20/2021] [Accepted: 01/04/2022] [Indexed: 11/29/2022]
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 375 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<0.05): 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. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ranya Selim
- Department of Gastroenterology and Hepatology, Henry Ford Health System, Detroit, MI
| | - Yueren Zhou
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI
| | - Loralee B Rupp
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI
| | - Sheri Trudeau
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI
| | - Sandra Naffouj
- Department of Internal Medicine, Henry Ford Health System, Detroit, MI
| | - Omar AlShamaa
- Department of Internal Medicine, Henry Ford Health System, Detroit, MI
| | | | - Syed-Mohammed Jafri
- Department of Gastroenterology and Hepatology, Henry Ford Health System, Detroit, MI.,Wayne State University School of Medicine, Detroit, MI
| | - Stuart C Gordon
- Department of Gastroenterology and Hepatology, Henry Ford Health System, Detroit, MI.,Wayne State University School of Medicine, Detroit, MI
| | - Antu Segal
- Wayne State University School of Medicine, Detroit, MI.,Transplant Institute, Henry Ford Health System, Detroit, MI
| | - Humberto C Gonzalez
- Department of Gastroenterology and Hepatology, Henry Ford Health System, Detroit, MI.,Wayne State University School of Medicine, Detroit, MI
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