Abstract
Liver transplantation is a complex procedure that requires multiple evaluations, including abstinence monitorization. While literature assessing the impact of different variables on relapse, survival, and graft loss exists, little is known about the predictive capacity of direct alcohol biomarkers. The primary aim of this study was to evaluate the prediction capacity of direct alcohol biomarkers regarding patient survival and clinical relapse. We hypothesized that patients screening positive for any of the experimental biomarkers would show an increased risk of clinical alcohol relapse and death. We conducted a retrospective data recollection from medical files of patients awaiting liver transplantation, who were at baseline screened with Peth, EtG in hair and urine, and EtS. We tested the prediction capacity of the biomarkers with two Cox-regression models. A total of 50 patients were included (84% men, mean age 59 years (SD = 6)). Biomarkers at baseline were positive in 18 patients. The mean follow-up time for this study was 26 months (SD = 10.4). Twelve patients died, liver transplantation was carried out in 12 patients, and clinical relapse was observed in eight patients. The only significant covariate in the Cox-regression models was age with clinical relapse, with younger patients being at greater risk of relapse. This study could not find a significant prediction capacity of direct alcohol biomarkers for mortality or clinical relapse during follow-up. Higher sample sizes might be needed to detect statistically significant differences. All in all, we believe that direct alcohol biomarkers should be widely used in liver transplantation settings due to their high sensitivity for the detection of recent drinking.
Highlights
Based on a previous study where a cohort of liver transplant candidates were transversally evaluated with phosphatidylethanol, EtG, Ets, and hair EtG [20], here we aimed to prospectively evaluate the prediction capacity of biomarker results regarding patient survival and clinical relapse
While the relatively small sample size warrants precaution when interpreting these findings, it appears that our results could be in line with previous publications suggesting that alcohol drinking might not be the leading factor of mortality in liver transplantation cohorts [15,23,24,25,26]
Despite the non-significant findings of our study, we believe it is important to highlight the use of direct alcohol biomarkers in liver transplantation studies
Summary
Liver transplantation is a complex procedure that requires multiple evaluations before and after the surgical replacement [1,2]. Graft loss and increased mortality have been postulated as the main reasons supporting the need for complete abstinence [5,6]. In this respect, previous literature clearly supports the link between alcohol relapse and a worsened prognosis [5]. Previous literature clearly supports the link between alcohol relapse and a worsened prognosis [5] This explains the introduction of the 6-months rule [7]
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