Carbohydrate‐Deficient Transferrin: Diagnostic Efficiency Among Patients with End‐Stage Liver Disease Before and After Liver Transplantation

Abstract

We tested the diagnostic validity of carbohydrate-deficient transferrin (CDT) as an indicator for relapse into elevated alcohol consumption among patients who were examined under follow-up treatment before (n = 147) and after (n = 102) orthotopic liver transplantation (OLT) in the outpatient-department of the University Hospital Department of Surgery in Hamburg-Eppendorf. CDT measurements were performed with two commercial kits in parallel (CDTect-RIA and CDT%-RIA). Short-term parameters of alcohol consumption (ethanol, methanol) indicated relapses into elevated alcohol consumption in 11.4% of the evaluated patients with alcoholic liver disease (ALD) before transplantation. Before OLT, median CDT values were determined to be elevated among patients with alcoholic as well as nonalcoholic end-stage liver diseases (NALD). Among patients with ALD, we found elevated CDT medians even in those who were successfully scheduled for OLT after long-term evidence of abstinence proved by biochemical short-term parameters and psychological tests. Both CDTect and CDT% assays had comparable low specificities in selected patient groups before transplantation. CDT% and CDTect were negatively correlated with the albumin level. Before the study ended, CDT was no longer implemented in the evaluation of whether an OLT should be administered. This was due to inconsistent results of CDT in ALD as well as NALD. After OLT, patients with ALD, as well as NALD, had statistically significant lower CDT medians than before OLT, which ranged within reference levels. We determined, according to CDT, elevated alcohol consumption subsequent to OLT in 4 of 13 patients with ALD who underwent transplantation during the study (median observation period: 10 months). CDT does not appear to be useful in evaluating patients before OLT. With regained specificity and high sensitivity in patients after OLT, CDT could be recommended as a standard instrument for quality control in patients with ALD after liver transplantation.

Carbohydrate-Deficient Transferrin: Validity of a New Alcohol Biomarker in a Sample of Patients with Diabetes and Hypertension

“…It generally decreases within 2 weeks of abstinence and will increase if persons resume drinking. 13,32,44 Quarterly testing of CDT levels in unstable diabetics or hypertensive patients may be indicated to monitor reductions or increases in drinking. CDT is the only alcohol biomarker sensitive enough to monitor reductions in alcohol use or relapse.…”

Detection of alcohol consumption in patients with alcoholic liver cirrhosis during the evaluation process for liver transplantation

“…If these patients remain abstinent, their prognosis is superior to that of patients with liver cirrhosis of other etiologies. However, continued alcohol consumption is considered an absolute contraindication for LT. [1][2][3][4] Therefore, the high percentages of relapse cases before LT (19%-50%) 5,6 and after LT (11%-80%) [7][8][9][10][11][12][13][14][15][16][17][18][19][20] pose a serious problem. [21][22][23][24][25] To ensure abstinence by the patient, a strict and systematic investigation is required.…”

“…Because of its short half-life and increased elimination in alcoholics, ethanol is also an unreliable method of testing. 8,[27][28][29] Since the 1980s, blood alcohol analysis has been established in forensic medicine for testing the blood levels of ethanol and other alcohols (eg, methanol, propanol-2, and acetone). Methanol is part of almost Abbreviations: ADH, alcohol dehydrogenase; ALC, alcoholic liver cirrhosis; LT, liver transplantation; SEC, serum ethanol concentration; SMC, serum methanol concentration; T0, time 0; T1, time 1; T2, time 2. every alcoholic beverage in different concentrations.…”

Relationship of Abnormal Chromatographic Pattern for Carbohydrate-Deficient Transferrin with Severe Liver Disease

“…exceeding 60 g of ethanol on most days) (Bergstrom and Helander, 2008). Despite its utility in identifying chronic heavy drinking, CDT assay methods have diminished specificity for heavy alcohol use in patients with liver disease and particularly cirrhosis (Heinemann et al, 1998;DiMartini et al, 2001). Case series using the relatively newer HPLC or capillary electrophoresis assays for %dCDT have shown that liver disease can be associated with a diminished chromatographic resolution of disialotransferrin from trisialotransferrin (Arndt et al, 2008;Stewart et al, 2010;Gonzalo et al, 2012), which is the likely cause of this diminished specificity for heavy drinking.…”