Utilization of biomarkers for alcohol use in candidates for liver transplantation with alcohol-associated liver disease

Although a set period of abstinence is no longer a requirement for transplant consideration in many liver transplantation programs, it is imperative to use valid monitoring tools to detect ongoing alcohol use in candidates for transplant. Urinary ethyl glucuronide (EtG) is an objective measure of alcohol use. This single-center retrospective study aims to describe the psychosocial characteristics of patients with alcohol-associated liver disease (ALD) who provided positive EtG tests in the pretransplant phase. Data were collected between May 1, 2018, and November 30, 2021, for all patients with ALD referred to our transplantation program (n = 497). Psychosocial characteristics and transplant outcomes were recorded for all patients. Patients with a positive EtG test were compared to patients who did not have a positive EtG test. A backward logistic regression analysis was performed to assess the factors associated with a positive EtG test. Of the 497 patients evaluated, 40 (8%) provided a positive EtG test, including at the initial clinic visit (n = 20), during medical evaluation (n = 14), and while on the waitlist (n = 6). Severe alcohol use disorder ( p < 0.01), consuming <10 daily standard drinks ( p = 0.011), and longer duration of daily alcohol use ( p = 0.028) were significantly associated with a positive EtG test. Psychiatric comorbidity and previous treatment for alcohol use disorder were not significantly associated with positive tests. A minority of patients with ALD provided a positive urine EtG in the pretransplant phase. Alongside clinical interviews, biomarker testing is an objective tool to identify ongoing alcohol use in patients with ALD.