Assessment of alcohol consumption in liver transplant candidates and recipients: the best combination of the tools available

Liver Transpl. 2014 Jul;20(7):815-22. doi: 10.1002/lt.23881. Epub 2014 May 26.


The detection of alcohol consumption in liver transplant candidates (LTCs) and liver transplant recipients (LTRs) is required to enable a proper assessment of transplant eligibility and early management of alcohol relapse, respectively. In this clinical setting, urinary ethyl glucuronide (uEtG), the Alcohol Use Disorders Identification Test for Alcohol Consumption (AUDIT-c), serum ethanol, urinary ethanol, carbohydrate-deficient transferrin (CDT), and other indirect markers of alcohol consumption were evaluated and compared prospectively in 121 LTCs and LTRs. Alcohol consumption was diagnosed when AUDIT-c results were positive or it was confirmed by a patient's history in response to abnormal results. Alcohol consumption was found in 30.6% of the patients. uEtG was found to be the strongest marker of alcohol consumption (odds ratio = 414.5, P < 0.001) and provided a more accurate prediction rate of alcohol consumption [area under receiving operating characteristic (ROC) curve = 0.94] than CDT (area under ROC curve = 0.63, P < 0.001) and AUDIT-c (area under ROC curve = 0.73, P < 0.001). The combination of uEtG and AUDIT-c showed higher accuracy in detecting alcohol consumption in comparison with the combination of CDT and AUDIT-c (area under ROC curve = 0.98 versus 0.80, P < 0.001). Furthermore, uEtG was the most useful marker for detecting alcohol consumption in patients with negative AUDIT-c results. In conclusion, the combination of AUDIT-c and uEtG improves the detection of alcohol consumption in LTCs and LTRs. Therefore, they should be used routinely for these patients.

MeSH terms

  • Aged
  • Alcohol Drinking*
  • Alcoholism / complications
  • Alcoholism / diagnosis
  • Biomarkers / blood
  • Biomarkers / urine
  • End Stage Liver Disease / complications*
  • End Stage Liver Disease / therapy*
  • Ethanol / blood
  • Ethanol / urine
  • Female
  • Glucuronates / urine
  • Humans
  • Liver Transplantation*
  • Male
  • Middle Aged
  • Odds Ratio
  • Prospective Studies
  • ROC Curve
  • Recurrence
  • Transferrin / analogs & derivatives
  • Transferrin / analysis


  • Biomarkers
  • Glucuronates
  • Transferrin
  • carbohydrate-deficient transferrin
  • ethyl glucuronide
  • Ethanol