Substance use and solid organ transplantation in adolescents and young adults: Current findings and implications

Abstract

Background Understanding the role of substance use is important in the equitable allocation of solid organs and may present an opportunity for improving outcomes among substance users who receive transplants. This scoping review presents findings related to substance use among pediatric and young adult transplant populations and suggests future directions. Methods A scoping review was conducted seeking studies related to substance use in pediatric and young adult transplant populations under the age of 39 years. Studies were deemed eligible if they collected data or addressed policy concerns and participants' mean age was below 39 years. Results Twenty‐nine studies were identified as eligible for this review. Overall, policies around substance use are largely inconsistent throughout both pediatric and adult transplant centers. Findings indicated that substance use among pediatric and young adult transplant recipients is similar to or lower than healthy peers. Few studies addressed marijuana use and opioid misuse, among other substances. Conclusions There is a general dearth of research on substance use in this population. The current findings suggest that substance use, although relatively less common, affects eligibility for transplant, may lead to poor outcomes, and affects medication adherence. Inconsistent substance use policies in transplant centers have the potential to result in bias. However, more research is needed on the effects of substance use among pediatric and young adult transplant candidates and recipients as well as on equitable policies for organ allocation for individuals who use substances.

Adult provider role in transition of care for young adult pediatric recipients of liver transplant: An expert position statement

“…The burden of a serious health condition is an additional stress in this high-risk population. In a meta-analysis of substance use among pediatric and YA recipients of transplant, rates were similar to nontransplant peers and may lead to poorer outcomes 10 . In adults, pretransplant substance use is strongly associated with posttransplant nonadherence to substance use restrictions 11 and greater postoperative complications, increased risk for hospitalizations, and diminished QoL 12 .…”

“…In a meta-analysis of substance use among pediatric and YA recipients of transplant, rates were similar to nontransplant peers and may lead to poorer outcomes. [10] In adults, pretransplant substance use is strongly associated with posttransplant nonadherence to substance use restrictions [11] and greater postoperative complications, increased risk for hospitalizations, and diminished QoL. [12] The need for a clear, directive policy regarding substance use, standard evaluation, and early intervention is supported by transplant providers.…”

Addressing Substance Use in the Adolescent Transplant Population

“…A recent review examined substance use among adolescents and young adults who were solid-organ transplant recipients or candidates [4]. The review found a total of 29 articles on substance use in this population with most being related to alcohol use and liver transplantation.…”

“…In general, substance use is believed to be similar or slightly below peer use, though there were no studies found on the use of cannabis or opiates in this population. There is some evidence that increasing substance use was associated with lower medication adherence though causality was limited by study methods [4]. Interestingly, the review noted one study [43] showing increased complexity of medication regimens was associated with lower alcohol use, with authors hypothesizing increased medication burden may lead to lifestyle changes and increased time management, which may limit youth from social outings where alcohol is present [4].…”

“…A 2022 nationally representative survey of 8th, 10th, and 12th graders showed the combined prevalence of past-year alcohol use was 32.2%, vaping was 23.0%, and any illicit drug use was 21.7% [3]. Data specific to transplant recipients are limited but suggest their rates of substance use are similar or slightly lower than their peers [4]. Substance use may impact eligibility for adolescents awaiting transplant and can negatively impact the health of adolescent transplant recipients indirectly via behavioral pathways and directly via biological mechanisms.…”