*Purpose: Phosphatidylethanol (PEth) is a phospholipid that forms in the presence of ethanol with a long half-life compared to other alcohol detection tests. PEth testing is highly sensitive and specific and has become an important factor in the process of pre-transplant evaluation as well as post-transplant follow-up. We evaluated the role of PEth in identifying recidivism and the impact of psychological intervention in identified patients.

*Methods: We performed a retrospective study at a large tertiary care center of all patients who had alcohol recidivism after liver transplant demonstrated by a positive PEth test between 1/2018 and 1/2020. PEth test was considered positive if level was > 20 ng/dl. Intervention by psychologic counseling and relapse prevention was offered and patients were followed to assess if they were able to abstain from alcohol following intervention.

*Results: A total of 20 patients (mean age 53.35 ± 8.97 years) were identified. All patients were white, and 14 (70%) were males. 17 patients (85%) had prior known alcoholic liver disease, 1 had nonalcoholic steatohepatitis (NASH), and 2 patients had cryptogenic liver disease. 19 patients had liver cirrhosis prior to transplant, and one had acute alcoholic hepatitis. 4 of the patients had pre-transplant PEth test and they were all negative. Mean PEth level post-transplant was 406 ng/ml. 11 patients agreed to undergo a psychological intervention to aid in alcohol cessation including relapse prevention (7/11), Alcoholic Anonymous (AA, 2/11), inpatient rehab + AA sessions (1/11), and relapse prevention + AA (1/11). 8 out of the 11 patients undergoing intervention reported abstinence on subsequent visits, however a follow-up PEth test was positive in 2 patients out of those 8 patients. 9 patients did not receive any intervention and continued to drink. 3 out of 9 had PEth test and it was positive (mean PEth level 297 ng/ml). 5 out 20 patients had graft rejection and only 1 of those 5 underwent a psychosocial intervention and stopped drinking. 2 patients died; both continued to drink post-transplant. One died of acute alcoholic hepatitis and was from the no intervention group, while the other underwent an intervention but nonetheless continued to drink and died due to a falling accident.

*Conclusions: PEth test has been largely implemented in the process of liver transplant evaluation and post-transplant follow-up to ensure abstinence and compliance with the transplant requirements. It has recently played a role in pre-transplant evaluation. In this study, we found that PEth testing identified patients who had recidivism and those who continued to use alcohol despite undergoing relapse prevention. Larger studies are needed to accurately evaluate the benefit of broader PEth testing in post-liver transplant follow-up.

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