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

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.

Phosphatidylethanol (PEth) for Monitoring Sobriety in Liver Transplant Candidates: Preliminary Results of Differences Between Alcohol-Related and Non-Alcohol-Related Cirrhosis Candidates

“…This and similar studies suggest PEth could have some advantages and/or give complementary information regarding alcohol intake over other direct alcohol biomarkers [22,23,26,28].…”

“…Hair treatment and other conditions might lower hEtG concentrations, while blood used for PEth detection is unlikely to be manipulated. Previous studies conducted in similar populations have also shown greater sensitivity for PEth [24,26].…”

“…PEth is formed after ingestion of alcohol and can be detected up to 12 days after a single drinking event [23]. PEth has been employed in numerous settings [24], including LT [24][25][26] and is recommended in various contexts in the 2020 German evidence-and consensus-based S3 guideline on alcohol [27]. Furthermore, it is reported to have higher sensitivity compared to uETG and EtS [28].…”

“…First, head-to-head comparisons among direct alcohol biomarkers remain scarce in transplant candidate studies. For example, only 2 previous studies, with limited sample size, have directly compared PEth to EtG in transplant candidates [24,26]. Therefore, new studies are needed to identify the analytic ability of diverse direct alcohol biomarkers.…”

Salivary Carbohydrate-Deficient Transferrin in Alcohol- and Nicotine-Dependent Males

“…Besides acetaldehyde, tobacco smoke is a source of oxidative stress and contains up to 3000 toxic substances, such as nicotine, carbon monoxide, nitrosamines and other aldehydes, which may damage the oral tissues [ 9 , 31 ]. Moreover, ROS generated during drinking and smoking, as well as non-oxidative metabolites of ethanol such as fatty acid ethyl esters (FAEEs) and the ethanol/water competition mechanism, might be involved in the resulting tissue damage [ 9 , 19 , 32 ].…”