Determination of ethyl glucuronide in hair improves evaluation of long-term alcohol abstention in liver transplant candidates

Authors

  • Martina Sterneck,

    Corresponding author
    1. Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg - Eppendorf, Hamburg, Germany
    • Correspondence

      Prof. Dr. Martina Sterneck

      Department of Hepatobiliary and Transplant Surgery

      University Medical Center Hamburg – Eppendorf

      Martinistrasse 52, 20246 Hamburg, Germany

      Tel: + 0049 40 7410 950236

      Fax: + 0049 40 7410 40051

      e-mail: sterneck@uke.de

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  • Michel Yegles,

    1. Laboratoire National de Santé – Toxicologie, Université du Luxembourg - Campus Limpertsberg, Luxembourg, Germany
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  • Gregor Rothkirch von,

    1. Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg - Eppendorf, Hamburg, Germany
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  • Katharina Staufer,

    1. Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg - Eppendorf, Hamburg, Germany
    2. Department of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
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  • Eik Vettorazzi,

    1. Department of Medical Biometry and Epidemiology, University Medical Center Hamburg – Eppendorf, Hamburg, Germany
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  • Karl-Heinz Schulz,

    1. Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg - Eppendorf, Hamburg, Germany
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  • Niels Tobias,

    1. Department of Clinical Pharmacology, Medical Center Bremen - Mitte, Bremen, Germany
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  • Christian Graeser,

    1. Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg - Eppendorf, Hamburg, Germany
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  • Lutz Fischer,

    1. Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg - Eppendorf, Hamburg, Germany
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  • Bjoern Nashan,

    1. Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg - Eppendorf, Hamburg, Germany
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    • Both authors contributed equally to this work as last authors.
  • Hilke Andresen-Streichert

    1. Department of Legal Medicine, University Medical Center Hamburg – Eppendorf, Hamburg, Germany
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    • Both authors contributed equally to this work as last authors.

Abstract

Background & Aims

Prior to listing patients for Orthotopic liver transplantation (OLT) an abstention period of 6 months is required. Ethyl glucuronide in the hair is a new reliable marker for the assessment of alcohol consumption. Here, the diagnostic value of determining the ethyl glucuronide concentration in the hair of liver transplant candidates was evaluated.

Methods

In 63 transplant candidates with alcoholic liver cirrhosis and 25 control patients with cirrhosis of other aetiologies alcohol markers, i.e. hEtG, urine EtG, blood ethanol, methanol and carbohydrate deficient transferrin were determined in parallel to an interview with a psychologist.

Results

A total of 19 (30%) transplant candidates admitted alcohol consumption within the last 6 months, while 39/63 (62%) were positive for at least one alcohol marker. In 52% of the 44 candidates denying alcohol consumption, abstention was disproved by detecting at least one positive alcohol marker, in 83% of cases by a positive hEtG result. In the control patients stating abstention from alcohol all hEtG tests were negative. No impact of renal or liver function on hEtG results was detected. A specificity of 98% and a positive predictive value of 92% were calculated for testing hEtG in proximal hair segment and applying a cut-off of 30 pg/mg.

Conclusions

In 52% of patients denying alcohol consumption within the last 6 months, alcohol abstention was disproved, in 83% of cases by hEtG testing. Therefore, hEtG is a promising new marker for the evaluation of long-term alcohol abstention in liver transplant candidates.

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