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

Background: Although a set period of abstinence is no longer a requirement for transplant consideration in many liver transplantation programs, it is imperative to utilize valid monitoring tools to detect ongoing alcohol use in transplant candidates. Urinary ethyl glucuronide (EtG) is an objective measure of alcohol use. This single centre retrospective study aims to describe the psychosocial characteristics of alcohol-associated liver disease (ALD) patients who provided positive EtG tests in the pre-transplant phase. Methods: Data was collected between May 1, 2018 and November 30, 2021 for all ALD patients 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. Results: Of the 497 patients evaluated, 40 (8%) provided a positive EtG test, including at initial clinic visit ( n =20), during medical evaluation (n=14) and while on the waitlist ( n =6). Severe alcohol use disorder (AUD) ( p <.01), consuming less than 10 daily standard drinks ( p =0.011) and longer duration of daily alcohol use ( p =.028) were significantly associated with a positive EtG test. Psychiatric comorbidity, daily alcohol consumption amount and previous treatment for AUD were not significantly associated with positive tests. Conclusion: A minority of ALD patients provided a positive urine EtG in the pre-transplant phase. Alongside clinical interview, biomarker testing is an objective tool to identify ongoing alcohol use in ALD patients.