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35th AM (2025) - Poster Session
Drunk without a Drink Auto-Brewery Syndrome Affect ...
Drunk without a Drink Auto-Brewery Syndrome Affecting Liver Transplant Candidacy
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Pdf Summary
This report from UT Southwestern Medical Center details the challenges auto-brewery syndrome (ABS) presents in liver transplant candidacy. ABS, a rare condition where gut microbes ferment carbohydrates to produce endogenous ethanol, can mimic alcohol intoxication symptoms. Diagnosis typically involves a carbohydrate challenge test with serial serum ethanol measurements showing elevated ethanol absent exogenous alcohol use.<br /><br />The case described involves a 51-year-old man with MASLD cirrhosis who was initially denied liver transplant listing due to suspicious elevated ethanol biomarkers and a positive PEth test despite denying alcohol consumption. After extensive evaluation, ABS was diagnosed via a glucose challenge test demonstrating a rise in serum ethanol from undetectable to 30 mg/dL within one hour under close observation. Following this diagnosis, transplant eligibility was granted.<br /><br />ABS complicates transplant eligibility frameworks that rely heavily on toxicology and patient self-reporting, raising ethical issues when undiagnosed ABS leads to inappropriate delays or transplant denials. Current transplant guidelines lack clear protocols for elevated ethanol biomarkers without documented alcohol use.<br /><br />Literature review identified at least four transplant candidates with ABS where delayed diagnosis caused critical delays in listing. The authors advocate for revising multidisciplinary transplant assessments to incorporate validated diagnostic algorithms for ABS. This would prevent misclassification of patients as having alcohol use disorder and enable timely access to life-saving transplantation.<br /><br />In conclusion, ABS—though rare and underrecognized—must be considered in transplant evaluations to avoid detrimental impacts on patient care. Awareness, appropriate diagnostic testing (glucose challenge with ethanol monitoring), and guideline updates are urgently needed to distinguish ABS from alcohol misuse and improve transplant outcomes in affected patients.
Keywords
Auto-brewery syndrome
ABS
Liver transplant candidacy
Endogenous ethanol production
Carbohydrate challenge test
MASLD cirrhosis
Ethanol biomarkers
Glucose challenge test
Transplant eligibility
Alcohol intoxication mimicry
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