Systematic Implementation of Alcohol Screening Program Using Urine Ethyl Glucuronide Can Identify Post-transplant Alcohol Use and Aid Return to Sobriety in Liver Transplant Recipients
1Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, MN, 2Division of Transplantation, University of Minnesota, Minneapolis, MN
Meeting: 2021 American Transplant Congress
Abstract number: 429
Keywords: Alcohol, Liver transplantation, Psychosocial, Screening
Topic: Clinical Science » Liver » Liver: Retransplantation and Other Complications
Session Information
Session Time: 7:30pm-8:30pm
Presentation Time: 7:50pm-8:00pm
Location: Virtual
*Purpose: Rates of liver transplantation (LT) for alcohol-related liver disease (ALD) are increasing, particularly in patients with acute alcoholic hepatitis. Post-LT alcohol (ETOH) use has significant implications for graft and overall survival. We report the findings from the implementation of a ETOH screening program using urine ethyl glucuronide (EtG) for post-LT patients with ALD at our center.
*Methods: As part of a prospective quality improvement initiative starting on 6/1/2016, patients who received LT for ALD underwent mandatory quarterly screening for ETOH use with urine EtG for the first 12 months after LT. Patients who had received a LT for any cause underwent urine EtG testing on an “as needed” basis when ETOH misuse was suspected. Adherence to screening was defined as completion of 4 urine EtG tests over the first 12 months after LT. A positive test was defined as urine EtG>500ng/ml, indicative of significant ETOH use. Positive tests resulted in the execution of a protocol involving the patient’s RN coordinator, hepatologist, social worker and chemical dependency resources.
*Results: 296 adult patients underwent LT from June 1st 2016 to 30th September 2020. 106 patients were transplanted for ALD- 103 patients with cirrhosis, 3 patients with ETOH hepatitis. Median age at LT was 53 years, 80 (75%) patients were male, 87 (85%) patients were white and median laboratory MELD at LT was 29. 69 (65%) patients had a pre-LT diagnosis of mental illness. Adherence to ETOH screening was low overall (Table 1). Reasons for non-adherence included hemodialysis, patient refusal and laboratory error. 11/106 (10.4%) patients who received LT for ALD were EtG(+). 2/11 (18%) patients successfully completed chemical dependency treatment. 3 patients who received a LT for non-ALD tested positive: 1 patient with HCV, 1 with AIH & 1 with NASH. Of note, an additional 11 patients who received LT prior to the study period were EtG(+), up to 6 years post-LT.
*Conclusions: Systematic implementation of regular ETOH biomarker screening identifies ETOH use in patients transplanted for ALD and can identify significant ETOH use in patients with no prior diagnosis of ETOH misuse. Despite the application of protocols for positive testing, mandatory chemical dependency treatment is difficult to enforce in the post-LT period.
| Year | Adherence (%) |
| 2016 | 2/7 (28.6%) |
| 2017 | 4/25 (16%) |
| 2018 | 3/13 (23.1%) |
| 2019 | 9/33 (27.3%) |
| 2020 | 15/28 (53.6%) |
| p-value (Fisher’s Exact) | 0.483 |
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. Systematic Implementation of Alcohol Screening Program Using Urine Ethyl Glucuronide Can Identify Post-transplant Alcohol Use and Aid Return to Sobriety in Liver Transplant Recipients [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/systematic-implementation-of-alcohol-screening-program-using-urine-ethyl-glucuronide-can-identify-post-transplant-alcohol-use-and-aid-return-to-sobriety-in-liver-transplant-recipients/. Accessed November 21, 2024.« Back to 2021 American Transplant Congress