title: Assessment of alcohol consumption in liver transplant candidates and recipients: the best combination of the tools available.
abstract: The detection of alcohol consumption in liver transplant candidates (LTCs) and liver transplant recipients (LTRs) is required to enable a proper assessment of transplant eligibility and early management of alcohol relapse, respectively. In this clinical setting, urinary ethyl glucuronide (uEtG), the Alcohol Use Disorders Identification Test for Alcohol Consumption (AUDIT-c), serum ethanol, urinary ethanol, carbohydrate-deficient transferrin (CDT), and other indirect markers of alcohol consumption were evaluated and compared prospectively in 121 LTCs and LTRs. Alcohol consumption was diagnosed when AUDIT-c results were positive or it was confirmed by a patient's history in response to abnormal results. Alcohol consumption was found in 30.6% of the patients. uEtG was found to be the strongest marker of alcohol consumption (odds ratio = 414.5, P < 0.001) and provided a more accurate prediction rate of alcohol consumption [area under receiving operating characteristic (ROC) curve = 0.94] than CDT (area under ROC curve = 0.63, P < 0.001) and AUDIT-c (area under ROC curve = 0.73, P < 0.001). The combination of uEtG and AUDIT-c showed higher accuracy in detecting alcohol consumption in comparison with the combination of CDT and AUDIT-c (area under ROC curve = 0.98 versus 0.80, P < 0.001). Furthermore, uEtG was the most useful marker for detecting alcohol consumption in patients with negative AUDIT-c results. In conclusion, the combination of AUDIT-c and uEtG improves the detection of alcohol consumption in LTCs and LTRs. Therefore, they should be used routinely for these patients.
authors.affiliation: Department of Medicine, University of Padua, Padua, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Piano
authors.forename: Lucio
authors.initials: L
authors.lastname: Marchioro
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Gola
authors.forename: Silvia
authors.initials: S
authors.lastname: Rosi
authors.forename: Filippo
authors.initials: F
authors.lastname: Morando
authors.forename: Marta
authors.initials: M
authors.lastname: Cavallin
authors.forename: Antonietta
authors.initials: A
authors.lastname: Sticca
authors.forename: Silvano
authors.initials: S
authors.lastname: Fasolato
authors.forename: Giovanni
authors.initials: G
authors.lastname: Forza
authors.forename: Anna
authors.initials: A
authors.lastname: Chiara Frigo
authors.forename: Mario
authors.initials: M
authors.lastname: Plebani
authors.forename: Giacomo
authors.initials: G
authors.lastname: Zanus
authors.forename: Umberto
authors.initials: U
authors.lastname: Cillo
authors.forename: Angelo
authors.initials: A
authors.lastname: Gatta
authors.forename: Paolo
authors.initials: P
authors.lastname: Angeli
mesh_terms: D000368:Aged; D000428:Alcohol Drinking; D000437:Alcoholism / Q000150:complications / Q000175:diagnosis; D015415:Biomarkers / Q000097:blood / Q000652:urine; D058625:End Stage Liver Disease / Q000150:complications* / Q000628:therapy*; D000431:Ethanol / Q000097:blood / Q000652:urine; D005260:Female; D005965:Glucuronates / Q000652:urine; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D012372:ROC Curve; D012008:Recurrence; D014168:Transferrin / Q000031:analogs & derivatives / Q000032:analysis
chemical_list: D015415:Biomarkers; D005965:Glucuronates; D014168:Transferrin; C056759:carbohydrate-deficient transferrin; C093924:ethyl glucuronide; D000431:Ethanol