Urinary ethyl glucuronide as a novel screening tool in patients pre- and post-liver transplantation improves detection of alcohol consumption

Staufer, Katharina; Andresen, H.; Vettorazzi, Eik; Tobias, Niels; Nashan, Bjoern; Sterneck, Martina

doi:10.1002/hep.24596

Cited by 125 publications

(142 citation statements)

References 39 publications

(56 reference statements)

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“…Recent studies using ethyl glucuronide have provided promising results. 6,26 For obvious reasons, selfreporting is not reliable because the denial of alcohol consumption is a typical symptom of addictive behavior. Because of its short half-life and increased elimination in alcoholics, ethanol is also an unreliable method of testing.…”

Section: See Editorial On Page 1267mentioning

confidence: 99%

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

Hempel

Greif-Higer²,

Kaufmann³

et al. 2012

Liver Transpl

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Alcoholic liver cirrhosis (ALC) is a commonly accepted indication for liver transplantation (LT). Any alcohol consumption is considered a contraindication for LT. However, the assessment of abstinence in everyday practice mostly relies on patient self-reporting, which must be considered highly unreliable. After consumption, ethanol is eliminated by alcohol dehydrogenase, with methanol accumulating in the blood. Methanol, which is known to be a sensitive and specific indicator for recent alcohol consumption, has not been used for verifying alcohol consumption in LT assessments yet. Therefore, the purpose of this study was to test the feasibility of using methanol testing to identify recent alcohol consumption in LT candidates during routine and short-notice appointments. We compared methanol and ethanol measurements with self-reported alcohol consumption for 41 patients with ALC during the evaluation process before they were accepted onto the waiting list. In 32 of the 92 blood samples drawn from these 41 patients during the study, a relapse was detected by the methanol test. Both the ethanol test results and the self-reported data were positive in only 3 cases. Thus, the methanol test identified 29 additional cases of alcohol consumption. Furthermore, the methanol test discovered recent alcohol consumption in 5 of 10 transplant patients when both self-reported data and ethanol test results were negative. As a part of blood alcohol analysis, the methanol test is more sensitive than self-reporting and ethanol testing for the detection of recent alcohol consumption. Also, short-notice appointments for blood alcohol analysis reveal more cases of alcohol relapse than routine, long-term appointments. The measurement of methanol as a sensitive screening test for recent alcohol consumption should be implemented both in law and in daily, routine practice.

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Section: See Editorial On Page 1267mentioning

confidence: 99%

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

Hempel

Greif-Higer²,

Kaufmann³

et al. 2012

Liver Transpl

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“…There are several studies on carbohydrate-deficient transferring (CDT) and urinary ethyl glucuronide. [42][43][44][45] Carbohydrate-deficient transferrin can be used for initial screening or to measure relapse. 39 Transferrin (glycoprotein) is secreted by liver.…”

Section: How To Assess Relapse After Liver Transplantmentioning

confidence: 99%

“…They found urinary EtG as best independent predictor of alcohol consumption in multivariate analysis with a positive predictive value of 89.3% and negative predictive value of 98.9%. 45 …”

Section: How To Assess Relapse After Liver Transplantmentioning

confidence: 99%

Liver Transplantation for Alcohol-Related Liver Disease

Choudhary

Kumar

Saigal

et al. 2016

Journal of Clinical and Experimental Hepatology

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Alcoholic liver disease (ALD) is a common indication for liver transplantation. It is a much debated indication for deceased donor liver transplantation due to organ shortage and potential of alcohol relapse after liver transplantation. A six-month abstinence before liver transplantation is required at most centers to decrease chances of alcohol relapse after liver transplantation. However, this rule is not relevant for patients with severe alcoholic hepatitis or severely decompensated patients who are unlikely to survive till 6 months. Long-term care of these patients after liver transplantation includes assessment of relapse, smoking, and surveillance of de novo malignancies. Current review discusses role of abstinence, factors affecting alcohol relapse, liver transplantation for alcoholic hepatitis, role of living donor liver transplantation, and long-term care of ALD patients who undergo liver transplantation. ( J CLIN EXP HEPATOL 2016;6:47-53) A lcoholic liver disease (ALD) is common indication for liver transplantation worldwide, 1,2 and is a common cause of decompensated cirrhosis and acute-on-chronic liver failure in India as well. 3,4 ALD has good outcome after liver transplantation that is comparable or better than other etiologies of liver transplantation. Recent European liver transplant registry data showed 73% 5-year and a 59% 10-year survival rate for ALD. 2 However, survival is lower in recipients who relapse to harmful pattern of drinking as noted in a systemic review of 13 studies by Rustad et al. 5 Liver transplantation for ALD leads to improvement in quality of life and employment rates. 6,7 During selection of these patients for liver transplantation, it is important to identify other alcohol-related problems like cardiomyopathy, chronic pancreatitis, skeletal muscle wasting, and neurotoxicities that may preclude or impair outcome of liver transplantation. 8 Patients who have lack of social support, are active smokers, and have psychiatric disorders or alcohol dependence should be listed only with reservations. 9 Smoking worsens the outcome of alcohol-related liver disease 10 and active smoking at the time of liver transplantation has been shown to be associated with post-transplant recidivism also. 11 PREDICTORS OF RELAPSEWhile liver transplantation improves functions of liver and cures complications of portal hypertension, it does not affect alcoholism and recipients may relapse again, sometimes to harmful levels of drinking, and pretransplant sobriety does not confirm sobriety after liver transplant. [12][13][14] Relapse may be in the form of occasional slips or harmful drinking pattern for a prolonged period; the later affects graft and patient survival. 5,11 Initially, 6-month abstinence was considered as a requirement before allocating organ to patients with ALD; however, it was based on poor quality small data. 15 The 6-month rule serves 2 purposes; it provides patient time to demonstrate a certain period of abstinence and patient may recover on medical management, and thus preempt...

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“…When considering pharmacological interventions for AUD treatment in ALD patients, one needs to take the severe liver markers [50,[54][55][56] .…”

Section: Pharmacological Interventionsmentioning

confidence: 99%

Addiction specialist's role in liver transplantation procedures for alcoholic liver disease

Dom¹

2015

WJH

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Although liver transplantation (LT) is performed increasingly for patients with end-stage alcoholic liver disease (ALD), the topic remains controversial. Traditionally, the role of an addiction specialist focused on the screening and identification of patients with a high risk on relapse in heavy alcohol use. These patients were in many cases subsequently excluded from a further LT procedure. Recently, awareness is growing that not only screening of patients but also offering treatment, helping patients regain and maintain abstinence is essential, opening up a broader role for the addiction specialist (team) within the whole of the transplant procedure. Within this context, high-risk assessment is proposed to be an indication of increasing addiction treatment intensity, instead of being an exclusion criterion. In this review we present an overview regarding the state of the art on alcohol relapse assessment and treatment in patients with alcohol use disorders, both with and without ALD. Screening, treatment and monitoring is suggested as central roles for the addiction specialist (team) integrated within transplant centers.

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Urinary ethyl glucuronide as a novel screening tool in patients pre- and post-liver transplantation improves detection of alcohol consumption

Cited by 125 publications

References 39 publications

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

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

Liver Transplantation for Alcohol-Related Liver Disease

Addiction specialist's role in liver transplantation procedures for alcoholic liver disease

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