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Reuters Health Information (2008-02-22): Substance use relapse rate low after organ transplantation


Substance use relapse rate low after organ transplantation

Last Updated: 2008-02-22 13:00:07 -0400 (Reuters Health)

NEW YORK (Reuters Health) - The risk of substance use relapse after solid organ transplantation is low, according to a report in the February issue of Liver Transplantation.

"Despite the fact that alcoholic liver disease is now among the most common indications for transplant, many physicians may continue to believe that patients with this condition are less than ideal candidates for transplant," Dr. Mary Amanda Dew from University of Pittsburgh School of Medicine in Pennsylvania told Reuters Health. "Our findings show that the risk of return to substance use during any given year of follow up is relatively low."

To estimate the rates of alcohol and illicit drug relapse after liver or other solid organ transplants, Dr. Dew and colleagues performed a meta-analysis of 54 reports on more than 3,600 transplant recipients who were former substance abusers.

The average rate of alcohol relapse after transplantation was 5.6 cases per 100 patients per year, the authors report, and the average rate of illicit drug relapse was 3.7 cases per 100 patients per year.

Fifty of the studies had been done in liver recipients, three in kidney recipients, and one in heart recipients. Still, the authors were able to determine that liver recipients had lower rates of illicit drug relapse and of noncompliance with immunosuppression regimens.

The only psychosocial variables significantly correlated with alcohol relapse were poor social support, a family history of alcohol abuse/dependence, and duration of pretransplantation abstinence of 6 months or less.

"Our meta-analysis suggested that abstinence of greater than 6 months did reduce risk of relapse after transplant, but the size of this effect was modest," Dr. Dew said. "In other words, it had some impact but the impact was not overwhelming."

"For the transplant team, I think the 6 month rule is a reasonable benchmark, because it is a time period that is realistic for many candidates and because it has modest predictive power," Dr. Dew explained. "I think it would be wrong, however, to believe that if a patient achieves 6 months, their risk of relapse is extremely low. If they achieve the 6 month point of abstinence, it means that they have made an important commitment that everyone (patient, family, transplant team) should work to maintain after the transplant."

In a related editorial , Dr. S. Tome and colleagues at the University of Wisconsin School of Medicine and Public Health in Madison write, "We know that predicting future alcohol or drug relapse remains imperfect, as is well demonstrated by the still contentious status of the 'six-month abstinence rule.' We need future studies that confront the issue of the suitability for transplantation of patients with duration of abstinence shorter than six months."

Dr. Dew told Reuters Health, "My colleagues and I are currently conducting a longitudinal study that follows individuals transplanted for alcoholic liver disease to examine the course of return to drinking and its predictors over a maximum of about 9 years after liver transplant. We believe that it is not simply history before transplant that predicts risk for relapse, but post-transplant factors related to the support systems that patients have in place and other stressors that they experience in the post-transplant years."

"Ultimately," Dr. Dew concluded, "we hope our work will identify ways in which transplant teams could work more effectively with patients after the transplant in order to help promote continued abstinence."

Liver Transpl 2008;14:159-172,127-129.

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