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Accurate measurement of alcohol use remains a challenge in the management of patients in the pre\u2010, peri\u2010, and post\u2010liver transplant settings. Blood 16:0\u201018:1 phosphatidylethanol (PEth) concentration is a sensitive and specific biomarker of binge and moderate, chronic alcohol use. As PEth has the longest detection window of available blood\u2010based direct alcohol biomarkers for moderate to heavy drinking, it shows promise as an indicator of patterns and chronicity of drinking. However, the utility of PEth in clinical liver transplantation is understudied. This study examines the association of PEth results with liver transplantation waitlist\u2010focused patient outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Retrospective data for all patients tested for PEth for a one\u2010year period at a tertiary care medical center with an active liver transplantation program were abstracted. Indications for PEth testing, liver transplantation waitlist\u2010related outcomes (e.g., listing and delisting) following testing and associations of PEth results with other parameters were analyzed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Over a one\u2010year period, 153 PEth tests were performed on 109 individuals. The most frequent indications for PEth testing were as an objective indicator of alcohol use patterns (86.3%) and to assess alcohol as a putative etiology of liver injury (13.7%). Of the 109 patients, 56 were medically appropriate for liver transplantation. Medically acceptable candidates with unfavorable transplantation waitlist\u2010related outcomes (delisting, deferment of transplant evaluation, deferment of listing until completion of recommended alcohol rehabilitation, and being deemed not a transplant candidate) were at least 3.41 times more likely to have a positive PEth test than those with favorable transplantation waitlist\u2010related outcomes (odds ratio 3.41, confidence interval 3.41 to \u221e, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This single\u2010center study reporting a comprehensive account of PEth utilization at a liver transplant center demonstrates that liver transplantation waitlist\u2010related outcomes are associated with PEth test results. Patients with positive PEth tests were more likely to have unfavorable transplant waitlist\u2010related outcomes. PEth testing has not been validated as a predictor of relapse to drinking in post\u2010transplant patients and because its utility in the pre\u2010transplant setting is unclear its use could lead to disparities in the selection of patients for liver transplantation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acer.14786","type":"journal-article","created":{"date-parts":[[2022,2,1]],"date-time":"2022-02-01T04:49:00Z","timestamp":1643690940000},"page":"581-588","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Positive blood phosphatidylethanol concentration is associated with unfavorable waitlist\u2010related outcomes for patients medically appropriate for liver transplantation"],"prefix":"10.1111","volume":"46","author":[{"given":"Claire S.","family":"Faulkner","sequence":"first","affiliation":[{"name":"Department of Medicine University of Arizona, College of Medicine  Phoenix Arizona USA"},{"name":"Department of Gastroenterology and Hepatology University of Nebraska Medical Center  Omaha Nebraska USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Collin M.","family":"White","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology University of Nebraska Medical Center  Omaha Nebraska USA"},{"name":"Division of Gastroenterology, Hepatology and Nutrition University of Louisville  Louisville Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wuttiporn","family":"Manatsathit","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology University of Nebraska Medical Center  Omaha Nebraska USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernadette","family":"Lamb","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology University of Nebraska Medical Center  Omaha Nebraska 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University of Louisville  Louisville Kentucky USA"},{"name":"Department of Pharmacology and Toxicology University of Louisville  Louisville Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9364-5796","authenticated-orcid":false,"given":"Loretta L.","family":"Jophlin","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology University of Nebraska Medical Center  Omaha Nebraska USA"},{"name":"Division of Gastroenterology, Hepatology and Nutrition University of Louisville  Louisville Kentucky USA"},{"name":"University of Louisville Alcohol Research Center University of Louisville  Louisville Kentucky USA"},{"name":"Hepatobiology and Toxicology Program University of Louisville  Louisville Kentucky 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