Background Retention in opioid substitution (OST) treatment is associated with substantial reductions in all cause and overdose mortality. This systematic review aims to identify both protective factors supporting retention in OST, and risk factors for treatment dropout. Methods A systematic search was performed using MEDLINE, Embase, PsycInfo, CINAHL and Web of Science (January 2001 to October 2019). Randomised controlled trials (RCTs) and observational cohort studies reporting on retention rates and factors associated with retention in OST were included. Factors associated with treatment retention and dropout were explored according to the Maudsley Addiction Profile. A narrative synthesis is provided. Results 67 studies were included in this review (4 RCTs and 63 observational cohort studies; N = 294,592), all assessing factors associated with retention in OST or treatment dropout. The median retention rate across observational studies was approximately 57% at 12 months, which fell to 38.4% at three years. Studies included were heterogeneous in nature with respect to treatment setting, type of OST, risk factor assessment, ascertainment of outcome and duration of follow-up. While the presence of such methodological heterogeneity makes it difficult to synthesise results, there is limited evidence to support the influence of a number of factors on retention, including age, substance use, OST drug dose, legal issues, and attitudes to OST. Conclusions Younger age, substance use particularly cocaine and heroin use, lower doses of methadone, criminal activity/incarceration, and negative attitudes to MMT appear to be associated with reduced retention in OST. A consensus definition of retention is required to allow for comparability across future studies.

Brain-dead patients with ongoing extracorporeal membrane oxygenation have more severe medical conditions than those without extracorporeal membrane oxygenation. However, kidney graft survival and function were no different than usual. Brain-dead patients with ongoing extracorporeal membrane oxygenation are suitable for organ procurement.

Aims To examine the risk of mortality associated with interruptions to the continuity of methadone maintenance treatment (MMT), including transfers between services, in opioid‐dependent individuals attending specialist addiction services. Design Retrospective cohort study using addiction services and primary care dispensing records, the National Methadone Register and National Drug‐Related Death Index (NDRDI). Setting Geographically defined population in Dublin, Ireland. Participants A total of 2899 people prescribed and dispensed methadone in specialist addiction services between January 2010 and December 2015. There were five exposure groups: weeks 1–4 following transfer between treatment providers; weeks 1–4 out of treatment; weeks 5–52 out of treatment; weeks 1–4 of treatment initiation; and weeks 5+ of continuous treatment (reference category). Measurements Primary outcome: drug‐related poisoning (DRP) deaths. Secondary outcome: all‐cause mortality (ACM). Mortality rates calculated by dividing number of deaths (DRP; ACM) in exposure groups by person‐years exposure. Unadjusted and adjusted Poisson regression (covariates age, sex, incarceration, methadone dose and comorbidities) estimated differences in mortality rates. Findings There were 154 ACM deaths, 55 (35.7%) identified as DRP deaths. No deaths were observed in the first month following transfer between treatment providers. The risk of DRP mortality was highest in weeks 1–4 out of treatment [adjusted relative risk (aRR = 4.04, 95% confidence interval (CI) = 1.43–11.43, P = 0.009] and weeks 1–4 of treatment initiation (ARR = 3.4, 95% CI = 1.2–9.64, P = 0.02). Similarly, risk of ACM was highest in weeks 1–4 out of treatment (ARR = 11.78, 95% CI = 7.73–17.94, P < 0.001), weeks 1–4 of treatment initiation (aRR = 5.11, 95% CI = 2.95–8.83, P < 0.001) and weeks 5–52 off treatment (aRR = 2.04, 95% CI = 1.2–3.47, P = 0.009). Conclusions Interruptions to the continuity of methadone maintenance treatment by treatment provider do not appear to be periods of risk for drug‐related poisoning or all‐cause mortality deaths. Risk of drug related poisoning and all‐cause mortality deaths appears to be greatest during the first 4 weeks of treatment initiation/re‐initiation and after treatment cessation.

This study aimed to evaluate how 5 preservation solutions for static cold storage affected kidney transplant outcomes. It included all first single kidney transplants during 2010-2014 from donations after brain death in the French national transplant registry, excluding preemptive transplants and transplants of kidneys preserved with a hypothermic perfusion machine. The effects of each preservation solution on delayed graft function (DGF) and 1-year transplant failure were evaluated with hierarchical multivariable logistic regression models. The study finally included 7640 transplanted kidneys: 3473 (45.5%) preserved with Institut Georges Lopez-1 solution (IGL-1), 773 (10.1%) with University of Wisconsin solution, 731 (9.6%) with Solution de Conservation des Organes et Tissus (SCOT, organ and tissue preservation solution), 2215 (29.0%) with Celsior, and 448 (5.9%) with histidine-tryptophan-ketoglutarate. Primary nonfunction rates did not differ by solution. After adjustment for donor, recipient, and transplant characteristics, the DGF risk was significantly lower with IGL-1 than with all other solutions (odds ratio [OR] 0.55, 95% confidence interval [CI] 0.48-0.64). Conversely, SCOT was associated with a DGF risk significantly higher than the other solutions (OR 2.69, 95% CI 2.21-3.27) and triple that of IGL-1 (OR 3.37, 95% CI 2.72-4.16). One year after transplantation, the transplant failure rate did not differ significantly by preservation solution. The difference between the groups for 1-year mean creatinine clearance was not clinically relevant. K E Y W O R D S clinical research/practice, delayed graft function (DGF), health services and outcomes research, kidney failure/injury, kidney transplantation/nephrology, organ perfusion and preservation, organ procurement and allocation 1 | INTRODUC TI ON Given the increased use of grafts from older donors or those with cardiovascular comorbidities and their lower resistance to cold ischemia, the management of organ preservation must be optimized. Different preservation strategies are used in kidney transplantation to minimize injury from cold ischemia and reperfusion. Continuous hypothermic machine perfusion of kidneys from donors after brain death significantly reduces the risk of delayed graft function (DGF) and improves graft survival compared with | 3427 LEGEAI Et AL.

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