Introduction Alcoholic liver disease (ALD) is a common indication for liver transplantation (LT) but recidivism is a significant concern. There is a need for careful assessment and support prior to LT, with monitoring for ongoing alcohol use an important aspect of care for patients on the waiting list (WL).
Methods Patients listed for LT in the UK are required to sign a contract committing them to lifelong abstinence from alcohol. Scheduled appointments for blood alcohol level (BAL) testing may only uncover the most dependent of those who continue to drink. Our transplant unit, with patient consent, conducts community based BAL testing without prior notice as well as breath testing at the time of admission for LT. We evaluated the role of this process in identifying individuals who continue to drink alcohol while claiming abstinence. An update of a retrospective analysis of all patients with a diagnosis of ALD, who were listed for LT from 2006 to 2011, was performed. Patients with a positive BAL and those removed from the WL were identified.
Results 206 abstinent patients with ALD were listed for LT after evaluation for risk of recidivism. Four patients on the WL returned a positive BAL at planned appointments and eight upon testing without prior notice. Seven of the latter patients had previously returned negative tests at planned appointments and all were removed from the WL in line with UK national policy. One patient returned a positive test at the time of admission for LT. In addition, two patients admitted to drinking (1 with positive – but below the usual cut-off – BAL tests) and were removed from the WL.
Conclusion Random BAL testing is a useful tool in identifying ongoing hidden alcohol use in patients with ALD listed for LT. 6.8% of patients with ALD were removed from the WL due to ongoing alcohol ingestion. These patients may have damaged their grafts through ongoing alcohol ingestion and may recover without LT if they were to become abstinent. Identification of these patients is also important in maintaining public confidence in appropriate allocation of scarce donor livers.
Competing interests None declared.
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