Pretransplant screening of sobriety with carbohydrate-deficient transferrin in patients suffering from alcoholic cirrhosis

Abstract

Sufficient assessment of potential candidates for orthotopic liver transplantation (OLT) is the most important factor for a low alcohol relapse rate after transplantation in patients suffering from alcoholic cirrhosis. In the current study the efficiency of pretransplant screening with carbohydrate-deficient transferrin (CDT) was analysed in patients on the waiting list for OLT. A prospective study was performed in 44 patients who had undergone OLT for alcoholic cirrhosis. All patients had had pretransplant assessment by a specialist psychologist and were found to have no problems with alcohol. Pre- and post-transplant CDT monitoring was performed. Overall, 790 CDT values were measured in the study population. The median observation period was 2.1 months before and 41.2 months after transplantation, respectively. In 35 patients (80%) pretransplant CDT values were found to be above the reference value, but only one patient suffered an alcohol relapse after transplantation. Of the nine patients (20%) who demonstrated normal CDT before transplantation, two suffered an alcohol relapse after transplantation. CDT is a very useful marker for the monitoring of an alcohol relapse in patients following OLT for alcoholic cirrhosis, as has been previously indicated. However, CDT does not appear to be useful as a pretransplant screening marker for selection of potential transplant candidates suffering from alcoholic cirrhosis.

Impaired homocysteine transsulfuration is an indicator of alcoholic liver disease

“…ALD patients had a mean MELD score of 11 ± 5.2 and Child score of 6.7 ± 1.6, distributed as 19 patients in Child class A and 21 in Child class B. The serum % CDT, an index of recent alcohol consumption, was similar and elevated in all ALD patients and in AD compared to HS, and was similar in ALD subjects who were actively drinking and who were abstinent at the time of the enrollment, confirming its limited value in the presence of ALD [16]. Serum folate levels were within normal range, but lower in ALD and AD compared to HS.…”

Diagnosis and Treatment of Alcohol‐Associated Liver Diseases: 2019 Practice Guidance From the American Association for the Study of Liver Diseases

“…Typically reported as the percentage of CDT (%CDT) per total transferrin, to account for differences in total transferrin levels, CDT has a half‐life of 2‐3 weeks . The utility of CDT is limited by its low sensitivity of 25%‐50% in several studies and by false‐positive results arising in patients with severe liver disease in the absence of alcohol use . However, posttransplant use of %CDT appears to be more accurate, likely due to improved liver function …”

Assessing the drinking status of liver transplant patients with alcoholic liver disease

“…CDT levels may be elevated in patients with severe liver disease, regardless of their current drinking status . In ALD patients, the sensitivity of CDT ranges from 0.46 to 0.73, with the specificity possibly as low as 0.70 .…”