Integration of Clinical Examination, Self-Report, and Hair Ethyl Glucuronide Analysis for Evaluation of Patients With Alcoholic Liver Disease Prior to Liver Transplantation.

CONTEXT

A large proportion of liver transplants (LTXs) are performed due to alcoholic liver disease (ALD) in the final stage of organ insufficiency. In order to list patients for LTX, transplant centers commonly require 6 months abstinence from alcohol. However, significant differences have been reported between alcohol intake as indicated by self-report and biochemical markers of alcohol.

OBJECTIVE

In the present study, the usefulness of ethyl glucuronide analysis in hair (hETG) was examined during the evaluation procedure before listing patients with ALD for an LTX.

DESIGN

Cross-sectional survey.

SETTING

Psychosomatic evaluation.

PATIENTS

Seventy patients with ALD prior to listing for an LTX.

INTERVENTIONS

According to clinical assessment before listing patients with ALD (n = 233) for an LTX, hETG analysis was only performed in the patients who were assumed to deny or underreport their alcohol consumption (n = 70).

MAIN OUTCOME MEASURES

The analysis of hETG by liquid chromatography-mass spectrometry, clinical interview.

RESULTS

By hETG analyses, 27 (38.6%) of the 70 patients tested positive for ongoing alcohol consumption.

CONCLUSIONS

Selective use of hETG based on the clinical interview rather than widespread screening is a possible way to detect excessive alcohol consumption in patients with ALD in the transplant setting. The primary evaluation of a patient's situation in its entirety should remain the superordinate standard procedure. An interdisciplinary approach to transplant candidates with an ALD is asked for.