Systematic Review: Treatment for Addictive Disorder in Transplant Patients

Abstract

Background and Objectives The number of patients with substance use disorders in need for organ transplantation is expected to increase. Patients with addictive disorders are considered a higher risk of negative outcomes after organ transplantation due to the impact of substance use upon medical status and adherence with treatment. The goal of this systematic review was to assess the current literature on treatment for addiction transplant candidates and recipients. Methods We conducted a literature search within four databases PubMed, MEDLINE, EMBASE, and PsycINFO for publications dated 1/1/1988 to 12/31/2018. Results Out of 3108 articles identified through database screening, 39 were included in the qualitative synthesis. Sixteen studies described addiction treatment in groups over five patients. All the articles included liver transplant patients, with only two studies including patients who needed a kidney or a heart transplant. Nine articles described treatment of alcohol use disorder exclusively, five focused on treatment of opioid use disorders. Although 9 of 16 studies were prospective, the variability of the treatment intervention, outcome measures, and control group when applicable prohibited a meaningful meta‐analysis of the results. Eight articles that described the case reports are analyzed separately. Discussion and Conclusions Promising treatment options for alcohol use disorder have been reported but more studies are needed to confirm their effectiveness and their feasibility. Methadone appears effective for opioid disorder in transplant patients. Scientific Significance To the best of our knowledge, this is the first systematic review on the treatment of addictive disorders in transplant patients. (Am J Addict 2020;29:445–462)

Creating the nursing care map in the evaluation of kidney transplant candidates: A scoping review and narrative synthesis

“…More specifically, the review also suggests that unhealthy nutrition, which can lead to increased body weight or the development of de novo diabetes mellitus post KT, should be identified and addressed through dietary improvement and weight control plans (Bloom & Crutchlow, 2008 ; Chan Chun Kong et al, 2020 ). The adoption of specialised monitoring strategies aiming to bring about lifestyle changes and reduce risk factors associated with drug use (Buahin & Curran, 2012 ; Corrêa et al, 2013 ; Luchsinger & Zimbrean, 2020 ) or severe pain is also encouraged. These lifestyle factors are described as contributing to increased patient visits to the healthcare system and missed appointments and examinations during the KT candidate assessment process (Hollisaaz et al, 2007 ).…”

“…The adoption of specialised monitoring strategies aiming to bring about lifestyle changes and reduce risk factors associated with drug use (Buahin & Curran, 2012;Corrêa et al, 2013;Luchsinger & Zimbrean, 2020) or severe pain is also encouraged. These lifestyle factors are described as contributing to increased patient visits to the healthcare system and missed appointments and examinations during the KT candidate assessment process (Hollisaaz et al, 2007).…”

The Combined Roles of Race/Ethnicity and Substance Use in Predicting Likelihood of Kidney Transplantation

“…27,31,33-38 In addition, consistent with candidate selection recommendations, 17-24 data show that, if active substance users demonstrate abstinence (eg, via any of an array of effective interventions 20,26,31 ), they can have successful posttransplant outcomes. 20,23,34,39-41 Despite such data, growing evidence indicates that active substance use substantially reduces patients’ chances for kidney transplantation, raising difficult concerns about equity in the transplantation process. 32,42-44…”

“…27,31,[33][34][35][36][37][38] In addition, consistent with candidate selection recommendations, [17][18][19][20][21][22][23][24] data show that, if active substance users demonstrate abstinence (eg, via any of an array of effective interventions 20,26,31 ), they can have successful posttransplant outcomes. 20,23,34,[39][40][41] Despite such data, growing evidence indicates that active substance use substantially reduces patients' chances for kidney transplantation, raising difficult concerns about equity in the transplantation process. 32,[42][43][44] The same psychosocial factors that may help to explain race/ethnicity disparities in kidney transplantation (eg, barriers to receipt of health care in general, fewer social and financial resources to support health, clinician bias 4,5,[8][9][10]15,45,46 ) also reduce the likelihood of substance use treatment.…”