Protocolized screening and detection of occult alcohol use before and after liver transplant: Lessons learned from a quality improvement initiative

N. Lim, T. M. Leventhal, M. J. Thomson, M. Hassan, J. Thompson, A. Adams, S. Chinnakotla, V. Humphreville, R. Kandaswamy, V. Kirchner, T. L. Pruett, L. Schuller, M. McCarty, J. Lake

Research output: Contribution to journalArticlepeer-review


Introduction: Detection of alcohol (ETOH) use with biomarkers provides an opportunity to intervene and treat patients with alcohol use disorder before and after liver transplant (LT). We describe our center's experience using urine ethyl glucuronide (EtG) and serum phosphatidylethanol (PEth) in alcohol screening protocols. Methods: Single-center, retrospective review of patients presenting for LT evaluation, patients waitlisted for LT for alcohol-associated liver disease (ALD), and patients who received a LT for ALD over a 12-month period, from October 1, 2019 through September 30, 2020. Patients were followed from waitlisting to LT, or for up to 12 months post-LT. We monitored protocol adherence to screening for ETOH use- defined as completion of all possible tests over the follow-up period- at the initial LT visit, while on the LT waitlist and after LT. Results: During the study period, 227 patients were evaluated for LT (median age 57 years, 58% male, 78% white, 54.2% ALD). Thirty-one patients with ALD were placed on the waitlist, and 38 patients underwent LT for ALD during this time period. Protocolized adherence to screening for alcohol use was higher for PEth for all LT evaluation patients (191 [84.1%] vs. 146 [67%] eligible patients, p <.001), in patients with ALD waitlisted for LT (22 [71%] vs. 14 (48%] eligible patients, p =.04) and after LT for ALD, 20 (33 [86.8%] vs. 20 [52.6%] eligible patients, p <.01). Few patients with a positive test in any group completed chemical dependency treatment. Conclusions: When screening for ETOH use in pre- and post-LT patients, protocol adherence is higher using PEth compared to EtG. While protocolized biomarker screening can detect recurrent ETOH use in this population, engagement of patients into chemical dependency treatment remains challenging.

Original languageEnglish (US)
Article numbere15036
JournalClinical Transplantation
Issue number9
StatePublished - Sep 2023

Bibliographical note

Funding Information:
We would like to acknowledge Rachel Belina, RN, Kristine Hinton, RN, Susanne Hollister, MSW, Katherine Lemke, RN, Jannae Lowe, MSW, Lynn Shriver, RN, Aynsley Smith, APRN, and Crystal Wilebski, RN, for their efforts as part of the M Health Fairview Liver Transplant PEAK (“Performance Excellence through Acquiring Knowledge”) Alcohol Workgroup. This research received no specific grant from any funding agency in the public, commercial or non-for-profit sectors.

Publisher Copyright:
© 2023 The Authors. Clinical Transplantation published by John Wiley & Sons Ltd.


  • alcohol
  • ethyl glucuronide
  • liver transplant
  • phosphatidylethanol
  • screening

PubMed: MeSH publication types

  • Journal Article


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