AbstractBackground & AimsFour gamma‐gultamyltransferases (GGT) fractions (b‐, m‐, s‐, and f‐GGT) have been identified in human plasma and their concentrations and ratios vary in different pathological conditions. To assess the behaviour of fractional GGT in cirrhotic patients evaluated for liver transplantation.MethodsThis was a single‐centre, cross‐sectional study; GGT fractions were determined by gel‐filtration chromatography.Results264 cirrhotic patients (215 males; median age 54.5 years) were included and compared against a group of 200 healthy individuals (100 males; median age 41.5). Median (25th–75th percentile) total and fractional GGT were higher in cirrhotics, with s‐GGT showing the greatest increase [36.6 U/L (21.0–81.4) vs. 5.6 U/L (3.2–10.2), P < 0.0001], while the median b‐GGT/s‐GGT ratio was lower in cirrhotics than in healthy controls [0.06 (0.04–0.10)] vs. 0.28 (0.20–0.40), P < 0.0001]. The ratio showed higher diagnostic accuracy (ROC‐AUC, 95% CI: 0.951, 0.927–0.969) then either s‐GGT (0.924, 0.897–0.947; P < 0.05) or total GGT (0.900, 0.869–0.925; P < 0.001). The diagnostic accuracy of the ratio was maintained (0.940, 0.907–0.963) in cirrhotic patients (n = 113) with total GGT values within the reference range. The s‐GGT fraction consisted of two components, with one (s2‐GGT) showing a significant positive correlation with serum aspartate aminotransferases, alanine aminotransferase, lactate dehydrogenases (LDH), alkaline phosphatases and bilirubin, and negative with albumin. The b‐GGT fraction showed a positive correlation with albumin, fibrinogen, and platelet counts, and negative with international normalized ratio, bilirubin and LDH.ConclusionsThe ratio performs as a sensitive biomarker of the liver parenchymal rearrangement, irrespective of aetiology of cirrhosis and presence of hepatocellular carcinoma, even in patients with total GGT values within the reference range.