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Return to alcohol use after LT (RAULT) affects a considerable proportion of recipients but lacks an objective diagnostic standard. We evaluated blood phosphatidylethanol (PEth) as a direct biomarker of RAULT and compared it with conventional clinical criteria (ClinC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We prospectively studied adult patients who underwent LT for ALD between 2008 and 2023. Since 2020, RAULT has been assessed quarterly using both ClinC and PEth (cut-off\u2009&gt;\u20090.05 \u00b5g\/L). Discordant results were interpreted using PEth as a biochemical comparator, given its higher objectivity and specificity compared with ClinC, although it was not considered a definitive diagnostic standard.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 143 patients (median age 56 years; 29% female; median post-LT follow-up 72 months), during a 3-year comparative study interval, RAULT was identified in 46 patients (32.2%) by PEth and in 69 patients (48.3%) by ClinC.\n                      <jats:italic>Concordance<\/jats:italic>\n                      between the two methods was observed in 98 cases (68.5%): in 63 cases (44.0%) for absence of RAULT and in 35 cases (24.5%) for presence of RAULT.\n                      <jats:italic>Discordance<\/jats:italic>\n                      occurred in 45 cases (31.5%), including 34 ClinC-positive\/PEth-negative cases (23.8%) and 11 ClinC-negative\/PEth-positive cases (7.7%). Quarterly and semi-annual PEth testing yielded comparable overall RAULT detection rates; however, quarterly testing identified a higher proportion of severe RAULT (16.1% vs. 12.6%). Time since LT independently predicted RAULT according to PEth (OR\u2009=\u20091.17; 95% CI 1.08\u20131.27; p\u2009=\u20090.0002).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Clinical criteria may overestimate the occurrence of RAULT after liver transplantation. Quarterly or semi-annual PEth testing provides additional objective insight into post-transplant alcohol use dynamics and may enhance monitoring of patients with AUD following LT.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s12072-026-11094-4","type":"journal-article","created":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T18:20:48Z","timestamp":1779474048000},"page":"1009-1019","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Phosphatidylethanol versus clinical criteria to diagnose alcohol use relapse after liver transplantation: a prospective cohort study"],"prefix":"10.1007","volume":"20","author":[{"given":"Lubomir","family":"Skladany","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8181-1937","authenticated-orcid":false,"given":"Svetlana Adamcova","family":"Selcanova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Zilincanova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jana","family":"\u010ciefov\u00e1","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel Jan","family":"Havaj","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karolina Kristina","family":"Sulejova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia","family":"Kubanek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Secnik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jana","family":"Zemlickova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomas","family":"Koller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Pablo","family":"Arab","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,22]]},"reference":[{"key":"11094_CR1","doi-asserted-by":"publisher","first-page":"359","DOI":"10.12659\/AOT.914690","volume":"24","author":"L Skladany","year":"2019","unstructured":"Skladany L, Adamcova Selcanova S, Koller T. 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