Substance use in kidney transplant candidates and its impact on access to kidney transplantation

Abstract

Background Due to the increasing public acceptance of substance use, it is important to understand the association between substance use and access to kidney transplant and its outcomes. Here, we assess the sociodemographic predictors of substance use and the association between substance use and KT access. Methods Predictors of substance use were examined using a multivariable‐adjusted multinomial logistic regression. The association between current substance use (tobacco and drug) and time from referral to listing or receipt of a KT was examined using Cox proportional hazards models. Results Of 2346 patients, the prevalence of current substance use was 17%. Predictors of current tobacco use were younger age, male sex, Caucasian ethnicity, being unemployed, and unmarried. Predictors of current drug use were younger age, male sex, Caucasian ethnicity, a history of non‐adherence, and a history of mental health disorder. Patients with tobacco use had a decreased likelihood of being cleared for KT (hazard ratio [HR]:0.83[0.70, 0.99]) and receiving a KT (HR:0.80 [0.66, 0.96]). No association was seen in this sample for patients with drug use (HR:0.88 [0.69, 1.11] for being cleared for KT and 0.88 [0.69, 1.14] for KT, respectively). Conclusions Tobacco use was associated with a decreased likelihood of access to KT whereas there was no statistically significant difference in access to KT between patients with or without drug use.

A Review of the Prevalence of Illicit Substance Use in Solid-Organ Transplant Candidates and the Effects of Illicit Substance Use on Solid-Organ Transplant Treatment Outcomes

“…Thirteen studies reported the rates of illicit substance use in solid-organ transplant candidates ( Table 1). Seven studies reviewed retrospective data [13][14][15][16][17][18]22], three studies used crosssectional assessment [10,[25][26], one study analyzed the national transplant registry [23], one study utilized prospective study design [19], and one study used a survey [24] to collect data. The sample sizes of these studies ranged from 59 [16] to 52,689 [23].…”

“…We found wide variations of the methodologies used in the included studies. Some studies investigated patients who are still in the process of evaluation for the suitability of a solid-organ transplant [ 10 , 13 - 14 ]. Some have included patients who are already listed for the transplant [ 15 ], whereas others assessed the patients in the post-transplant period [ 16 - 18 ].…”

“…Some have included patients who are already listed for the transplant [ 15 ], whereas others assessed the patients in the post-transplant period [ 16 - 18 ]. Most of the studies included in this research were retrospective studies [ 13 - 14 , 17 ]. We found only one study that utilized prospective study design [ 19 ].…”

“…The authors (Alhamed) suspected that those with substance abuse behaviors (that would preclude transplant) were not included in the study, and the diverse coding practice among various treatment providers did not follow the usual rigor that is typically conducted in clinical trials and researches. Similarly, Tang et al (2019) found out that the prevalence of any substance use was 17%, current drug use was 5%, and 67% of the current drug users were cannabis users [ 14 ]. About 15% had historical drug use, with 54% had cannabis use among historic drug users [ 14 ].…”

“…Similarly, Tang et al (2019) found out that the prevalence of any substance use was 17%, current drug use was 5%, and 67% of the current drug users were cannabis users [ 14 ]. About 15% had historical drug use, with 54% had cannabis use among historic drug users [ 14 ].…”