Urinary ethyl glucuronide (uEtG) as a marker for alcohol consumption in liver transplant candidates: a real-world cohort

Abstract

Background In order to reduce alcohol relapse after liver transplantation (LT), the German national guidelines for waiting-list maintenance and organ allocation demand a minimum 6-month period of alcohol abstinence pre-LT, confirmed by measuring urinary ethyl glucuronide (uEtG).

Methods Between January 2015 and June 2016, uEtG was measured at least once in 339 cirrhotic patients with an indication for LT at the University Medical Center Mainz. uEtG was measured with an enzyme-linked immunosorbent assay (ELISA) screening test (cutoff value: 500 µg/L). For uEtG values ≥ 500 µg/L, liquid chromatography–mass spectrometry (LC-MS/MS) was performed as a confirmatory assay. Data were collected prospectively in a transplant database.

Results Of the 339 potential liver transplant candidates, uEtG was negative in 86.4 %. Most patients were male (64.3 %), with an average age of 56.42 ± 10.1 years. In the multivariate analysis, mean corpuscular volume (p = 0.001), urinary creatinine (p = 0.001), gamma-glutamyl transferase (p = 0.001), and hemoglobin (p = 0.003) were significantly associated with a positive uEtG test result. The sensitivity of the ELISA screening test was 100 % for uEtG values > 2000 µg/L, as confirmed by LC-MS/MS.

Conclusion uEtG is an effective parameter to reveal alcohol consumption by patients on the waiting list for LT. The sensitivity of the ELISA is excellent for uEtG values > 2000 µg/L, for which LC-MS/MS confirmation could be omitted.

Zusammenfasung

Hintergrund In der deutschen Richtlinie für die Wartelistenführung und die Organvermittlung gem. § 16 Abs. 1 S. 1 Nrn. 2 u. 5 TPG wird eine durch Bestimmung von Ethylglucuronid im Urin (uEtG) nachweisliche, absolute Alkoholabstinenzzeit von mindestens 6 Monaten als Voraussetzung für eine Lebertransplantation (LT) bei einer ethyltoxischen Leberzirrhose gefordert.

Methoden Zwischen Januar 2015 und Juni 2016 wurde an der Universitätsmedizin Mainz uEtG mindestens einmal bei 339 Patienten mit Leberzirrhose und Indikation für eine LT mittels ELISA Screening Test (cut off: 500 µg/l) gemessen. Bei Werten ≥ 500 µg/l erfolgte ein massenspektrometrischer Bestätigungstest. Die Daten wurden prospektiv in einer LT-Datenbank erhoben.

Ergebnisse Von den 339 potenziellen LT Kandidaten waren 86,4 % uEtG-negativ. Die meisten Patienten waren männlich (64,3 %) und durchschnittlich 56,42 ± 10,1 Jahre alt. In der multivariaten Analyse waren MCV (p = 0,001), Urin-Kreatinin (p = 0,001), Gamma-Glutamyltransferase (GGT) (p = 0,001) und Hämoglobin (Hb) (p = 0,003) signifikant mit einem positiven uEtG assoziiert. Die Sensitivität des ELISA Screeningtest war bei uEtG-Werten > 2000 µg/l 100 %.

Schlussfolgerung In unserer Real-World-Kohorte konnte uEtG als valider und zuverlässiger Marker zum Nachweis eines Alkoholkonsums bei Patienten auf der Warteliste zur Lebertransplantation bestätigt werden. Zudem konnten wir zeigen, dass der ELISA-Screenintest bei uEtG-Werten > 2000 µg/l eine exzellente Sensitivität hat und somit auf den massenspektrometrischen Bestätigungstest verzichtet werden kann.

Key words

liver transplantation - ethyl glucuronide - alcohol

Schlüsselwörter

Lebertransplantation - Ethylglucuronid - Alkohol

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