Title: Liver transplantation and opioid dependence.

Author(s): M. Koch & P. Banys

Source: Journal of the American Medical Association
ISSN: 0098-7484
Issue: 285(8) 2001 1056-1058

Abstract: Chronic hepatitis C is the leading cause for liver transplantation in the United States. Intravenous drug use, the major risk factor, accounts for approximately 60% of hepatitis C virus transmission. Information from the United Network of Organ Sharing (UNOS) does not address substance use among liver transplantation patients. The objective was to identify addiction-related criteria for admission to the UNOS liver transplantation waiting list and posttransplantation problems experienced by patients who are prescribed maintenance methadone. A mail survey of all 97 adult US liver transplantation programmes (belonging to UNOS) in March 2000 with telephone follow-up was conducted in May and June 2000. The main outcome measures were Programs' acceptance and mangement of patients with past or present substance use disorder. Of the 97 programs surveyed, 87 (90%) responded. All accept applicants with a history of alcoholism or other addictions, including heroin dependence. Eighty-eight percent of the responding programmes require at least 6 months of abstinence from alcohol; 83% from illicit drugs. Ninety-four percent have addiction treatment requirements. Consultations from substance abuse specialists are obtained by 86%. Patients receiving methadone maintenance are accepted by 56% of the responding programmes. Aproximately 180 patients receiving methadone maintenance are reported to have undergone liver transplantation. Most liver transplantation programmes have established policies for patients with substance use disorders. Opiate-dependent patients receiving opiate replacement therapy seem underrepresented in transplantation programmes. Little anecdotal evidence for negative impact of opiate replacement therapy on liver transplantation outcome was found. Policies requiring discontinuation of methadone in 32% of all programmes contradict the evidence base for efficacy of long-term replacement therapies and potentially result in relapse of previously stable patients.