Session Name: Liver: Recipient Selection
Session Date & Time: None. Available on demand.
*Purpose: Alcohol (ETOH) is an important cause of cirrhosis in the US today. Screening patients for ETOH use prior to LT is important to identify and treat ETOH misuse. We report the findings from the implementation of a ETOH screening program for pre-LT patients at our center.
*Methods: As part of a QI initiative starting on 6/1/2016, all patients undergoing LT evaluation had one-time testing for ETOH use, while patients undergoing LT evaluation for ALD underwent mandatory quarterly screening for ETOH use, with urine ethyl glucuronide (EtG). Any LT evaluation patient underwent EtG testing whenever ETOH misuse was suspected. Adherence to screening was defined as completion of one-time EtG testing in all LT evaluation patients and completion of quarterly EtG tests until LT or waitlist removal. A positive test was defined as urine EtG>500ng/ml, indicative of significant ETOH use. In the event of a positive test, the LT evaluation was placed on hold and a protocol was initiated. Upon satisfactory completion of the protocol, LT evaluation was resumed or the patient was re-activated on the LT waiting list.
*Results: 868 patients started a LT evaluation from 6/1/2016 to 9/30/2020. Median age at LT evaluation was 58, 538 (62%) patients were male, 281 (33%) patients had ALD and 670 (78%) patients were white. 177 patients were listed for ALD- median age 56, 126 (71%) male and 147 (83%) white. Adherence rates to one-time screening for all LT evaluation patients and routine EtG testing in patients listed for ALD were high but decreased in 2020 (Table 1). Reasons for non-adherence included inpatient LT evaluation, hemodialysis & patient refusal. 31 patients were EtG(+) over the study period- 4 patients with NASH, 4 patients with HCV and 1 patient with AIH. In patients listed for ALD, 8/177 (4.5%) patients had a positive EtG test. 8/31 (25.8%) patients completed chemical dependency treatment after EtG(+) and 3/31 (9.67%) patients later underwent LT.
*Conclusions: ETOH screening is feasible and successfully identifies patients actively engaging in ETOH consumption, even in patients with no formal diagnosis of ALD. Implementing systematic ETOH screening in pre-LT patients identifies patients at highest risk for post-LT relapse and provides a comprehensive framework for additional chemical dependency resources to allow the best chance of post-LT success.
|Year||All LT Evaluation||Listed ETOH|
|2016||73/97 (75%)||25/28 (89%)|
|2017||133/171 ((78%)||25/26 (96%)|
|2019||183/223 (82%)||50/55 (91%)|
|2020||105/167 (63%)||15/20 (75%)|
To cite this abstract in AMA style:Lim N, Leventhal T, Thomson M, Hassan M, Thompson J, Chinnakotla S, Kirchner V, Pruett T, Kandaswamy R, Humphreville V, Adams A, Lake J. Implementation of an Alcohol Screening Program Identifies Active Pre-transplant Drinking and Allows Engagement in Chemical Dependency Treatment [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/implementation-of-an-alcohol-screening-program-identifies-active-pre-transplant-drinking-and-allows-engagement-in-chemical-dependency-treatment/. Accessed June 20, 2021.
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