Former Substance Abusers Rarely Relapse After Organ Transplantation, Pitt Study Finds

Only about six percent of former alcoholics and four percent of former illicit drug users will relapse into their addictions in any given year following an organ transplant, according to a study by University of Pittsburgh researchers published in this month’s issue of Liver Transplantation.

“Substance abuse can lead to serious organ diseases for which transplantation is increasingly considered an acceptable treatment,” noted senior author Mary Amanda Dew, professor of psychiatry at the University of Pittsburgh and the director of the Clinical Epidemiology Program at the Western Psychiatric Institute and Clinic (WPIC) of UPMC. “Still, the transplant community remains concerned about these patients resuming their harmful behaviors once the transplant has been done.”

Studies have suggested vast disparities in the prevalence of addiction relapse after transplantation. By conducting a meta-analysis of studies published between 1983 and 2005, the researchers sought to establish precise estimates of the rates of alcohol and drug relapse in individuals receiving liver or other solid organ transplants. They also looked for associations between relapse and many pretransplant or psychosocial characteristics.

The researchers included 54 studies (all but four pertaining to liver recipients) that described more than 3,600 former substance abusers who had received transplants. They examined the following post-transplant outcomes: alcohol relapse, heavy alcohol use, illicit drug relapse, tobacco use, nonadherence to immunosuppressants, and nonadherence to clinic appointments.

The average rate for alcohol relapse was approximately six cases per 100 persons per year of observation. The average rate for relapse to heavy alcohol use was 2.5 per 100 persons per year of observation. The average relapse to illicit drug use was 3.7 cases per 100. Relapse rates for the other studied outcomes ranged from two to 10 cases per 100.

Because of the amount of data available, relapse risk factors could be assessed only for alcohol use. While demographics and pretransplant characteristics showed little correlation with relapse, poor social support, family alcohol history, and pretransplant abstinence of less than six months showed small but significant associations with relapse.

“Future research should focus on improving the prediction of risk for substance abuse relapse, and on testing interventions to promote continued abstinence post-transplant.

Interventions are important because, although the risk of relapse is small during any given year, as the years add up the likelihood of relapse increases,” Dew concluded.

Coauthors of the study include Andrea F. DiMartini, Jennifer Steel, Annette DeVito Dabbs, and Mark Unruh from the University of Pittsburgh; Larissa Myaskovsky, from Pitt and the Center for Health Equity Research and Promotion at the VA Pittsburgh Health Care System; and Joel Greenhouse, from Carnegie Mellon University.

Dew was supported by funding provided by the International Transplant Nurses Society, Astellas Pharma, and the National Institute for Mental Health.

WPIC is considered to be one of the nation’s foremost university-based psychiatric care facilities and one of the world’s leading centers for research and treatment of mental health disorders. WPIC houses the Department of Psychiatry within Pitt’s School of Medicine and is the flagship of UPMC Behavioral Health, the psychiatric specialty division of the University of Pittsburgh Medical Center.