Comparison of new methods for measuring carbohydrate-deficient transferrin (CDT): application to a public health approach for the prevention of alcoholic cirrhosis.

Recently, Xin et al. (1991) developed an isoelectric focusing/Western blot (IEF/WB) procedure for serum CDT measurement which compares favorably with the micro anion-exchange chromatography/radioimmunoassay technique of Stibler et al. (1986). The latter is now marketed in a modified version (Stibler et al., 1991), gives values that correlate with those of IEF/WB but are nearly 5-fold lower, with significantly lesser sensitivity for detecting recent drinkers; these are also less well discriminated from non-drinking patients with liver disease. We are now able to screen for heavy drinking using IEF/WB. Some of the complications of liver disease are then detected with standard liver function tests. Next we need to detect precirrhotic lesions (perivenular and/or perisinusoidal fibrosis) which, at present, requires a liver biopsy. These patients--at high risk to rapidly develop cirrhosis upon continuation of drinking--should be subjected to intensive treatment, instituted prior to their medical or social disintegration, with the goal to prevent progression to cirrhosis.