Phosphatidylethanol for Monitoring Alcohol Use in Liver Transplant Candidates: An Observational Study

Pablo Barrio,Wolfgang Weinmann,Lidia Teixidor,Anna Lligoña,Friedrich M Wurst,Antoni Gual,Michel Yegles

doi:10.3390/jcm9093060

Abstract

Liver transplantation remains an essential procedure for many patients suffering from alcoholic liver disease. Alcohol use monitoring remains paramount all through the stages of this complex process. Direct alcohol biomarkers, with improved specificity and sensibility, should replace traditional indirect markers. Phosphatidylethanol (PEth) has been recently tested in alcoholic liver disease patients, but more evidence is needed, especially in comparison with other direct biomarkers. We conducted an observational study among patients awaiting liver transplantation. We analyzed Peth in blood, ethylglucuronide (EtG) in hair and urine and ethylsulphate (EtS) in urine, using mass spectrometry methods. In addition, transaminases, and self-reports were analyzed. A total of 50 patients were included (84% men, mean age 59 years (SD = 6)). 18 patients (36%) screened positive for any marker. Self-reports were positive in 3 patients. EtS was the biomarker with more positive screens. It also was the most frequently exclusive biomarker, screening positive in 7 patients who were negative for all other biomarkers. PEth was positive in 5 patients, being the only positive biomarker in 2 patients. It showed a false negative in a patient admitting alcohol use the previous week and screening positive for EtG and EtS. Hair EtG was positive in 3 patients who had negative Peth, EtG. EtG did not provide any exclusive positive result.A combination of biomarkers seems to be the best option to fully ascertain abstinence in this population. Our study suggest EtS might also play a significant role.

Highlights

Alcoholic liver disease (ALD) remains the most frequent etiology in life-threatening liver disease in a majority of European countries and the US [1,2]
Return to drinking after transplantation has been clearly linked to transplantation failure, allograft fibrosis and allograft loss [32], the use of highly sensitive and specific alcohol direct biomarkers seems warranted in this population
A selected population awaiting liver transplantation with relatively stable levels of transaminases and ggt, we found that 36% of the patients screened positive for at least one of the available biomarkers

Summary

Introduction

Alcoholic liver disease (ALD) remains the most frequent etiology in life-threatening liver disease in a majority of European countries and the US [1,2]. The rule does not come without controversy [8,9,10], with some authors arguing in favor of a more dimensional evaluation of the relapse risk, instead of a binary and time-constrained assessment [11]. It seems almost self-evident that in a majority of ALD patients undergoing or waiting for LT, abstinence assessment and monitorization remains critical, and challenging. Traditional indirect alcohol biomarkers remain far from accurate [12,13,14] They are affected by other medical conditions and variables such as age and sex. Self-reports frequently tend to underreport drinking [15,16,17,18]

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