The DRAM Vol. 4(7) - Relapse After an Organ Transplant

Long term alcohol abuse and or dependence can lead to organ disease, sometimes creating a need for organ transplant. Returning to substance use after a transplant increases the risk of medical complications and even death (e.g., Kran & DiMartini, 2005). Organs for transplant are scarce (Organ Procurement and Transplantation Network, 2008).  Some observers believe recipient prioritization should take alcohol use history into account.  This week we examine a meta-analysis to measure relapse among people who require organ transplants and have a history of alcohol misuse (Dew, DiMartini, Steel, De Vito Dabbs, Myaskovsky, et al., 2008).

Data
Meta-analysis of 54 studies, included 3,651 participants and 13,821 person years of observation

Methods
Authors searched six databases (e.g., PsychInfo, MEDLINE) for studies addressing non-adherence to the medical regimen following organ transplantation

Inclusion criteria for studies

• Written in English language
• Published between 1981-2005
• Did not use the same dataset as any other study
• Sample size of 10 people or more
• Indication that prior to transplant, participants had histories of substance abuse, dependence, or diseases that indicated these disorders
• Includes substance use history, relapse, and treatment non-adherence behavior

Outcomes
Relapse to any alcohol use and to heavy alcohol use

Table 1.Pooled estimates of post-transplantation rates of relapse to alcohol use (cases per 100 persons per year)

Results

• Average number of observation years per study = 4 (SD=2.7, range=0.9-12.9)
• The Q-statistic in Table 1 indicates a wide range of relapse rates across studies
• Risk for post-operative relapse higher for patients of hospitals that had no requirement for 6-month pre-operative sobriety (average effect size: r = .21 (95% CI 0.11-0.31) p<.01)

Limitations

• Retrospective self report methodology
• No control group: unclear whether risk for post-operative drinking is greater among samples with an abuse history than other transplant populations

Discussion
This study reminds us about the likelihood for relapse among transplant patients who had histories of alcohol abuse or dependence. Although popular opinion seems to lean towards sanctions on those with alcohol misuse histories, hospitals can use empirical evidence to guide careful selection of transplant candidates.  This study’s results suggest one selection criteria could be a longer period of abstinence before the planned surgery.  Another guideline, not examined in this study, could be participation in substance abuse treatment before and after the surgery.

What do you think? Comments can be addressed to Leslie Bosworth.

References
Dew, M. A., DiMartini, A. F., Steel, J., De Vito Dabbs, A., Myaskovsky, L., Unruh, M., et al. (2008). Meta-analysis of risk for relapse to Substance use after transplantation of the liver or other solid organs. Liver Transplantation, 14, 159-172.

Kran, L. E., & DiMartini, A. (2005). Psychiatric and psychosocial aspects of liver transplantation. Liver Transplantation, 11, 1157-1168.

Organ Procurement and Transplantation Network. Data, View Data Reports, National Data. Retrieved June 4, 2008, from http://www.optn.org/latestData/step2.asp