Urine test detects alcohol use in liver patients

World Health Matters: Italy by Gary Finnegan – Alcoholic liver disease is one of the most common reasons for liver transplantation but around half of liver transplant recipients struggle with alcohol relapse. This can cause complications with the graft, reducing their chances of survival.

Doctors often seek to reduce the risk of relapse by requiring liver transplant candidates to take a test which measures alcohol levels. However, there has been some debate about which detection method is optimal.

Researchers in Italy say a combination of urinary ethyl glucuronide (uEtG) and the Alcohol Use Disorders Identification Test for alcohol consumption (AUDIT-c) is the best method for testing alcohol levels and helps to select patients for liver transplants.

“Assessing alcohol consumption is crucial in the selection of liver transplant candidates,” explains Dr. Paolo Angeli from the University of Padova in Italy. “Equally important is the ability to detect alcohol use in liver transplant recipients so early intervention for alcohol relapse can take place.”

In a study published in Liver Transplantation, a journal of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, experts tested the effectiveness of uEtG, AUDIT-c, serum ethanol (sETOH), urinary ethanol (uETOH), and carbohydrate-deficient transferrin (CDT) in assessing drinking status in 121 liver transplant candidates and recipients. Participants provided blood and urine samples at each visit to detect all alcohol markers.

Researchers detected alcohol consumption in 31% of participants, with uEtG found to be the strongest marker of alcohol use. Compared to CDT, uEtG was also more accurate in predicting the amount of alcohol consumption. When used together, uEtG and AUDIT-c were more accurate in assessing alcohol consumption than CDT and AUDIT-c. In patients with a negative AUDIT-c, uEtG was the most effective indicator of drinking status.

The authors recommend that AUDIT-c and uEtG be routinely used in transplant candidates and recipients to monitor drinking status.

“It’s vital that patients abstain from damaging drinking behaviour following liver transplant to avoid graft loss or even death. When used together, uEtG and AUDIT-c provide an important tool in the management of transplant patients at risk for alcohol relapse,” said Dr Angeli.