Transplants Can Proceed Despite Substance Abuse

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Transplants Can Proceed Despite Substance Abuse
Transplants Can Proceed Despite Substance Abuse

FT. LAUDERDALE, Fla.—Substance abuse by renal transplant recipients does not significantly affect graft and patient outcomes, according to new data presented at the American Society of Transplantation 10th Annual State of the Art Winter Symposium.

The impact of substance use on transplant outcomes has been investigated extensively in liver transplant recipients and to a lesser extent in cardiac transplant recipients. The new study is the first to examine the impact of prior substance abuse on outcomes in renal transplant recipients.

The study compared 79 prior substance abusers (mean age 54 years) and 52 non-abusers (mean age 51 years) and found no significant difference in either the rates of acute rejection (13% in those with a substance abuse history compared with 6% in those with no prior history) or delayed graft function (DGF) (22% vs. 23% in those with a substance abuse history compared with no prior history).  The five-year graft survival rates were 82% and 80% in the groups with and without a substance abuse history. The five-year patient survival rates were 88% and 90%, respectively. 

Most kidney transplant center programs in the United States consider current or recent substance use as possible contraindications to transplantation. Centers typically require current substance users to abstain from all use for a predetermined period. 

Some programs may require patients to enter rehab before they get transplanted. It is theorized that addictive behavior may affect compliance or adherence after transplantation, which is paramount in renal transplantation.  However, there are no data to support this concept and few studies have looked at this issue.

As a result of study findings, “there is no reason to exclude prior substance abusers from transplantation because their outcomes were similar to those who did not have any strong history of substance abuse,” said co-investigator Nicole Sifontis, PharmD, Clinical Associate Professor at the Temple University School of Pharmacy in Philadelphia.

That view is shared by co-investigator John A. Daller, MD, PhD, Director of the Abdominal Organ Transplant Program at Temple University Hospital in Philadelphia. “People who have had a previous history of substance abuse but are not currently using should not have additional hurdles or barriers to get transplanted,” Dr. Daller said.

Future studies should look at intervention strategies that may be beneficial in this patient population, he said.

“Centers may use history of substance abuse as a contraindication and require periods of abstinence of three to six months, but there are no data to support any particular number,” Dr. Daller said. The studies that have looked at the effect of substance abuse on transplant outcomes have been done on liver and heart transplant recipients, he said.

“Those are lifesaving transplants, but with renal transplants there is always a consideration of dialysis and it is more of an elective surgery,” Dr. Daller said. “But we know that getting a transplant is better than staying on dialysis. We see this with obese patients and now we are seeing it with patients with a history of substance abuse. Our data shows no difference in survival rates between those who were previous substance abusers and those who were not.”

The investigators considered subjects to have a history of substance abuse if they reported past, recent or current use of tobacco, alcohol, and/or intravenous drugs. All the patients received induction therapy with basiliximab or thymoglobulin, with maintenance immunosuppression consisting of tacrolimus, MMF and corticosteroid therapy.

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