ORIGINAL ARTICLE
Substance use and solid organ transplantation in adolescents and young adults: Current findings and implications
Bianca R. Campagna,
Rachel A. Annunziato,
Corresponding Author
Bianca R. Campagna
Department of Psychology, Fordham University, Bronx, New York, USA
Icahn School of Medicine at Mount Sinai, New York, New York, USA
Correspondence
Bianca R. Campagna, Department of Psychology, Fordham University, 226 Dealy Hall, 441 E. Fordham Road, Bronx, NY 10458, USA.
Email: [email protected]
Search for more papers by this authorRachel A. Annunziato
Department of Psychology, Fordham University, Bronx, New York, USA
Icahn School of Medicine at Mount Sinai, New York, New York, USA
Search for more papers by this authorBianca R. Campagna,
Rachel A. Annunziato,
Corresponding Author
Bianca R. Campagna
Department of Psychology, Fordham University, Bronx, New York, USA
Icahn School of Medicine at Mount Sinai, New York, New York, USA
Correspondence
Bianca R. Campagna, Department of Psychology, Fordham University, 226 Dealy Hall, 441 E. Fordham Road, Bronx, NY 10458, USA.
Email: [email protected]
Search for more papers by this authorRachel A. Annunziato
Department of Psychology, Fordham University, Bronx, New York, USA
Icahn School of Medicine at Mount Sinai, New York, New York, USA
Search for more papers by this authorAbstract
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.
CONFLICT OF INTEREST STATEMENT
The authors have no conflicts of interests to disclose.
Open Research
DATA AVAILABILITY STATEMENT
Data sharing is not applicable to this article as no new data were created or analyzed in this study.
REFERENCES
- 1 United Network for Organ Sharing (UNOS). Transplant trends. Accessed 12/05/22 https://unos.org/data/transplant-trends/
- 2Parker R, Armstrong MJ, Corbett C, Day EJ, Neuberger JM. Alcohol and substance abuse in solid-organ transplant recipients. Transplantation. 2013; 96(12): 1015-1024. doi:10.1097/TP.0b013e31829f7579
- 3Fabbri KR, Anderson-Haag TL, Spenningsby AM, Israni A, Nygaard RM, Stahler PA. Marijuana use should not preclude consideration for kidney transplantation. Clin Transplant. 2019; 33(10):e13706.
- 4Rice JP, Eickhoff J, Agni R, Ghufran A, Brahmbhatt R, Lucey MR. Abusive drinking after liver transplantation is associated with allograft loss and advanced allograft fibrosis. Liver Transpl. 2013; 19(12): 1377-1386.
- 5 World Health Organization. Adherence to Long-Term Therapies: Evidence for Action. World Health Organization; 2003.
- 6Oliva M, Singh TP, Gauvreau K, VanderPluym CJ, Bastardi HJ, Almond CS. Impact of medication non-adherence on survival after pediatric heart transplantation in the USA. J Heart Lung Transplant. 2013; 32(9): 881-888.
- 7Sandhu GS, Khattak M, Woodward RS, et al. Impact of substance abuse on access to renal transplantation. Transplantation. 2011; 91(1): 86-93. doi:10.1097/TP.0b013e3181fc8903
- 8Chuncharunee L, Yamashiki N, Thakkinstian A, Sobhonslidsuk A. Alcohol relapse and its predictors after liver transplantation for alcoholic liver disease: a systematic review and meta-analysis. BMC Gastroenterol. 2019; 19(1): 150. doi:10.1186/s12876-019-1050-9
- 9Osna NA, Donohue TM Jr, Kharbanda KK. Alcoholic liver disease: pathogenesis and current management. Alcohol Res. 2017; 38(2): 147-161.
- 10Liangpunsakul S, Haber P, McCaughan GW. Alcoholic liver disease in Asia, Europe, and North America. Gastroenterology. 2016; 150(8): 1786-1797. doi:10.1053/j.gastro.2016.02.043
- 11Majumder P, Sarkar S. 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. Cureus. 2020; 12(7):e8986. doi:10.7759/cureus.8986
- 12Minelli E, Liang BA. Transplant candidates and substance use: adopting rational health policy for resource allocation. U Mich JL Reform. 2010; 44: 667.
- 13Brown RS Jr. Transplantation for alcoholic hepatitis—time to rethink the 6-month “rule”. Mass Medical Soc. 2011; 365: 1836-1838.
- 14Herrick-Reynolds KM, Punchhi G, Greenberg RS, et al. Evaluation of early vs standard liver transplant for alcohol-associated liver disease. JAMA Surg. 2021; 156(11): 1026-1034.
- 15Weeks SR, Sun Z, McCaul ME, et al. Liver transplantation for severe alcoholic hepatitis, updated lessons from the World's largest series. J Am Coll Surg. 2018; 226(4): 549-557. doi:10.1016/j.jamcollsurg.2017.12.044
- 16Lee BP, Terrault N. Early liver transplantation for severe alcoholic hepatitis: moving from controversy to consensus. Curr Opin Organ Transplant. 2018; 23(2): 229-236.
- 17Beresford TP, Everson GT. Liver Transplantation for Alcoholic Liver Disease: Bias, Beliefs, 6-Month Rule, and Relapse—But Where are the Data? . WB Saunders Philadelphia; 2000: 777-778.
- 18Maldonado JR, Dubois HC, David EE, et al. The Stanford integrated psychosocial assessment for transplantation (SIPAT): a new tool for the psychosocial evaluation of pre-transplant candidates. Psychosomatics. 2012; 53(2): 123-132.
- 19Becker JH, Shemesh E, Shenoy A, et al. The utility of a pre-transplant psychosocial evaluation in predicting post-liver transplant outcomes. Prog Transplant. 2021; 31(1): 4-12.
- 20Gumabay FM, Novak M, Bansal A, et al. Pre-transplant history of mental health concerns, non-adherence, and post-transplant outcomes in kidney transplant recipients. J Psychosom Res. 2018; 105: 115-124.
- 21Nghiem DM, Gomez J, Gloston GF, Torres DS, Marek RJ. Psychological assessment instruments for use in liver and kidney transplant evaluations: scarcity of evidence and recommendations. J Pers Assess. 2020; 102(2): 183-195. doi:10.1080/00223891.2019.1694527
- 22Bleyer A, Barr R. Cancer in young adults 20 to 39 years of age: overview. Semin Oncol. 2009; 36(3): 194-206. doi:10.1053/j.seminoncol.2009.03.003
- 23Pilapil M, DeLaet D. Health risk behaviors in adolescents and young adults with special health care needs. Curr Opin Pediatr. 2015; 27(1): 132-137.
- 24Pai ALH, Ostendorf HM. Treatment adherence in adolescents and young adults affected by chronic illness during the health care transition from pediatric to adult health care: a literature review. Child Health Care. 2011; 40(1): 16-33. doi:10.1080/02739615.2011.537934
- 25Steinberg L. Risk taking in adolescence: new perspectives from brain and behavioral science. Curr Dir Psychol Sci. 2007; 16(2): 55-59.
- 26 Key substance use and mental health indicators in the United States: Results from the 2020 National Survey on Drug Use and Health. 2021.
- 27Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018; 169(7): 467-473. doi:10.7326/m18-0850
- 28Monnin K, Lofton AM, Naclerio C, et al. Understanding substance use policies and associated ethical concerns: a survey of pediatric transplant centers. Pediatr Transplant. 2021; 25(4):e13984. doi:10.1111/petr.13984
- 29Zhu J, Chen PY, Frankel M, Selby RR, Fong TL. Contemporary policies regarding alcohol and marijuana use among liver transplant programs in the United States. Transplantation. 2018; 102(3): 433-439. doi:10.1097/tp.0000000000001969
- 30Lee BP, Vittinghoff E, Hsu C, et al. Predicting low risk for sustained alcohol use after early liver transplant for acute alcoholic hepatitis: the sustained alcohol use post–liver transplant score. Hepatology. 2019; 69(4): 1477-1487.
- 31Im GY, Kim-Schluger L, Shenoy A, et al. Early liver transplantation for severe alcoholic hepatitis in the United States--a single-center experience. Am J Transplant. 2016; 16(3): 841-849. doi:10.1111/ajt.13586
- 32Hamilton AJ, Caskey FJ, Casula A, Ben-Shlomo Y, Inward CD. Psychosocial health and lifestyle behaviors in young adults receiving renal replacement therapy compared to the general population: findings from the SPEAK study. Am J Kidney Dis. 2019; 73(2): 194-205. doi:10.1053/j.ajkd.2018.08.006
- 33Singal AK, Arsalan A, Dunn W, et al. Alcohol-associated liver disease in the United States is associated with severe forms of disease among young, females and Hispanics. Aliment Pharmacol Ther. 2021; 54(4): 451-461. doi:10.1111/apt.16461
- 34Lee BP, Dodge JL, Terrault NA. Excess mortality after liver transplantation in young women with alcohol-associated liver disease. Am J Gastroenterol. 2021; 116(3): 551-559. doi:10.14309/ajg.0000000000001007
- 35Lind RC, Sze YK, de Vries W, et al. Achievement of developmental milestones in young adults after liver transplantation in childhood. Pediatr Transplant. 2015; 19(3): 287-293. doi:10.1111/petr.12448
- 36Vimalesvaran S, Souza LN, Deheragoda M, et al. Outcomes of adults who received liver transplant as young children. EClinicalMedicine. 2021; 38:100987. doi:10.1016/j.eclinm.2021.100987
- 37Wray J, Waters S, Radley-Smith R, Sensky T. Adherence in adolescents and young adults following heart or heart-lung transplantation. Pediatr Transplant. 2006; 10(6): 694-700. doi:10.1111/j.1399-3046.2006.00554.x
- 38Dobbels F, Decorte A, Roskams A, Van Damme-Lombaerts R. Health-related quality of life, treatment adherence, symptom experience and depression in adolescent renal transplant patients. Pediatr Transplant. 2010; 14(2): 216-223. doi:10.1111/j.1399-3046.2009.01197.x
- 39Xiao N, Stolfi A, Malatesta-Muncher R, et al. Risk behaviors in teens with chronic kidney disease: a study from the Midwest pediatric nephrology consortium. Int J Nephrol. 2019; 2019:7828406.
- 40Evon DM, Burker EJ, Sedway JA, Cicale R, Davis K, Egan T. Tobacco and alcohol use in lung transplant candidates and recipients. Clin Transplant. 2005; 19(2): 207-214. doi:10.1111/j.1399-0012.2005.00320.x
- 41Harry R, Fraser-Irwin C, Mouat S, Gane E, Munn S, Evans HM. Long-term follow up of paediatric liver transplant recipients: outcomes following transfer to adult healthcare in New Zealand. Inter Med J. 2015; 45(5): 580-582. doi:10.1111/imj.12721
- 42Yavuz A, Tuncer M, Erdoğan O, et al. Is there any effect of compliance on clinical parameters of renal transplant recipients? Transplant Proc. 2004; 36(1): 120-121. doi:10.1016/j.transproceed.2003.11.052
- 43Mauthner O. The New Normal: A Bourdieusian Examination of Living into Young Adulthood Being a Paediatric Heart Transplant Recipient. Ph.D. University of Toronto (Canada); 2014.
- 44Falk RE. Identity and Adjustment: Experiences of the Organ Transplant Recipient. D.Clin.Psy. Canterbury Christ Church University (United Kingdom); 2015.
- 45Tong A, Morton R, Howard K, McTaggart S, Craig JC. "When I had my transplant, I became normal." adolescent perspectives on life after kidney transplantation. Pediatr Transplant. 2011; 15(3): 285-293. doi:10.1111/j.1399-3046.2010.01470.x
- 46Cote D, Chirichella T, Noon K, et al. Abdominal organ transplant center tobacco use policies vary by organ program type. Elsevier. 2016; 48(6): 1920-1926.
- 47Leard LE, Holm AM, Valapour M, et al. Consensus document for the selection of lung transplant candidates: an update from the International Society for Heart and Lung Transplantation. J Heart Lung Transplant. 2021; 40(11): 1349-1379. doi:10.1016/j.healun.2021.07.005
- 48Omoloja A, Chand D, Greenbaum L, et al. Cigarette smoking and second-hand smoking exposure in adolescents with chronic kidney disease: a study from the Midwest pediatric nephrology consortium. Nephrol Dial Transplant. 2011; 26(3): 908-913. doi:10.1093/ndt/gfq475
- 49Dew MA, Dimartini AF, De Vito DA, et al. Adherence to the medical regimen during the first two years after lung transplantation. Transplantation. 2008; 85(2): 193-202. doi:10.1097/TP.0b013e318160135f
- 50Phillips KA, Thrush PT, Lal AK, et al. Marijuana in pediatric and adult congenital heart disease heart transplant listing: a survey of provider practices and attitudes. Pediat Transpl. 2020; 24(2):e13640. doi:10.1111/petr.13640
- 51Neyer J, Uberoi A, Hamilton M, Kobashigawa JA. Marijuana and listing for heart transplant: a survey of transplant providers. Cir Heart Fail. 2016; 9(7):e002851. doi:10.1161/CIRCHEARTFAILURE.115.002851
- 52Secunda K, Gordon EJ, Sohn MW, et al. National survey of provider opinions on controversial characteristics of liver transplant candidates. Liver Transpl. 2013; 19(4): 395-403. doi:10.1002/lt.23581
- 53Alhamad T, Koraishy FM, Lam NN, et al. Cannabis dependence or abuse in kidney transplantation: implications for posttransplant outcomes. Transplantation. 2019; 103(11): 2373-2382. doi:10.1097/tp.0000000000002599
- 54Kotwani P, Saxena V, Dodge JL, Roberts J, Yao F, Hameed B. History of marijuana use does not affect outcomes on the liver transplant waitlist. Transplantation. 2018; 102(5): 794-802. doi:10.1097/TP.0000000000002045
- 55Fleming JN, Lai JC, Te HS, Said A, Spengler EK, Rogal SS. Opioid and opioid substitution therapy in liver transplant candidates: a survey of center policies and practices. Clin Transplant. 2017; 31(12):e13119.
- 56Kim H, Jarrett JB, Ingemi AI, Lichvar A. Opioid use practices of kidney transplant centers in the United States: a national survey of institutional practices. JACCP J Am College Clin Phar. 2021; 4(5): 587-593. doi:10.1002/jac5.1413
10.1002/jac5.1413 Google Scholar
- 57Schuler MS, Tucker JS, Pedersen ER, D'Amico EJ. Relative influence of perceived peer and family substance use on adolescent alcohol, cigarette, and marijuana use across middle and high school. Addict Behav. 2019; 88: 99-105.
- 58Quigley J, USE COS, PREVENTION. Alcohol use by youth. Pediatrics. 2019; 144(1):e20191356. doi:10.1542/peds.2019-1356
- 59Mauro PM, Carliner H, Brown QL, et al. Age differences in daily and nondaily cannabis use in the United States, 2002–2014. J Stud Alcohol Drugs. 2018; 79(3): 423-431. doi:10.15288/jsad.2018.79.423
- 60Yan K, Forman L. Cannabinoid use among liver transplant recipients. Liver Transpl. 2021; 27(11): 1623-1632.
- 61Rai HS, Winder GS. Marijuana use and organ transplantation: a review and implications for clinical practice. Curr Psychiatry Rep. 2017; 19(11): 91. 10.1007/s11920-017-0843-1
- 62Greenan G, Ahmad SB, Anders MG, Leeser A, Bromberg JS, Niederhaus SV. Recreational marijuana use is not associated with worse outcomes after renal transplantation. Clin Transplant. 2016; 30(10): 1340-1346.
- 63Serrano Rodriguez P, Strassle PD, Barritt AS, et al. Marijuana consumption in liver transplant recipients. Liver Transpl. 2019; 25(5): 734-740. doi:10.1002/lt.25417
- 64Leino AD, Emoto C, Fukuda T, Privitera M, Vinks AA, Alloway RR. Evidence of a clinically significant drug-drug interaction between cannabidiol and tacrolimus. Am J Transplant. 2019; 19(10): 2944-2948. doi:10.1111/ajt.15398
- 65Rohan VS, Taber DJ, Patel N, et al. Impact of a multidisciplinary multimodal opioid minimization initiative in kidney transplant recipients. Clin Transplant. 2020; 34(10):e14006. doi:10.1111/ctr.14006
- 66Lentine KL, Lam NN, Naik AS, et al. Prescription opioid use before and after kidney transplant: implications for posttransplant outcomes. Am J Transplant. 2018; 18(12): 2987-2999. doi:10.1111/ajt.14714
- 67Lentine KL, Lam NN, Xiao H, et al. Associations of pre-transplant prescription narcotic use with clinical complications after kidney transplantation. Am J Nephrol. 2015; 41(2): 165-176. doi:10.1159/000377685
- 68Abbott KC, Fwu CW, Eggers PW, Eggers AW, Kline PP, Kimmel PL. Opioid prescription, morbidity, and mortality in US transplant recipients. Transplantation. 2018; 102(6): 994-1004. doi:10.1097/tp.0000000000002057
- 69Chisholm-Burns MA, Spivey CA, Potukuchi PK, et al. Association between posttransplant opioid use and immunosuppressant therapy adherence among renal transplant recipients. Nephron. 2020; 144(7): 321-330. doi:10.1159/000507257
- 70Underwood JM, Brener N, Thornton J, et al. Overview and methods for the youth risk behavior surveillance system—United States, 2019. MMWR Supplements. 2020; 69(1): 1-10.
- 71Mathur AK, Ashby VB, Fuller DS, et al. Variation in access to the liver transplant waiting list in the United States. Transplantation. 2014; 98(1): 94-99. doi:10.1097/01.Tp.0000443223.89831.85
- 72Becerra AZ, Chan KE, Eggers PW, et al. Transplantation mediates much of the racial disparity in survival from childhood-onset kidney failure. J Am Soc Nephrol. 2022; 33: 1265-1275. doi:10.1681/asn.2021071020
- 73Wilson CR, Sherritt L, Gates E, Knight JR. Are clinical impressions of adolescent substance use accurate? Pediatrics. 2004; 114(5): e536-e540. doi:10.1542/peds.2004-0098
- 74Roberts SC, Zahnd E, Sufrin C, Armstrong M. Does adopting a prenatal substance use protocol reduce racial disparities in CPS reporting related to maternal drug use? A California case study. J Perinatol. 2015; 35(2): 146-150.
- 75Wu T, Morgan TR, Klein AS, Volk ML, Saab S, Sundaram V. Controversies in early liver transplantation for severe alcoholic hepatitis. Ann Hepatol. 2018; 17(5): 759-768.
- 76Ubel PA, Jepson C, Baron J, Mohr T, McMorrow S, Asch DA. Allocation of transplantable organs: do people want to punish patients for causing their illness? Liver Transpl. 2001; 7(7): 600-607. doi:10.1053/jlts.2001.25361
- 77Stroh G, Rosell T, Dong F, Forster J. Early liver transplantation for patients with acute alcoholic hepatitis: public views and the effects on organ donation. Am J Transplant. 2015; 15(6): 1598-1604. doi:10.1111/ajt.13176
- 78Harrison LD, Martin SS, Enev T, Harrington D. Comparing Drug Testing and Self-Report of Drug Use among Youths and Young Adults in the General Population. Substance Abuse and Mental Health Services Administration, Office of Applied Studies; 2007. doi:10.1037/e637122007-001
10.1037/e637122007-001 Google Scholar
- 79Large MM, Smith G, Sara G, Paton MB, Kedzior KK, Nielssen OB. Meta-analysis of self-reported substance use compared with laboratory substance assay in general adult mental health settings. Int J Methods Psychiatr Res. 2012; 21(2): 134-148.
- 80Williams RJ, Nowatzki N. Validity of adolescent self-report of substance use. Subst Use Misuse. 2005; 40(3): 299-311.
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