title: Polysubstance abuse in liver transplant patients and its impact on survival outcome.
abstract: BACKGROUND
  Alcohol-related end-stage liver disease was the most common reason for liver transplant in the 1990s. Currently, hepatitis C virus (HCV) is the most common reason for transplant. The major HCV risk factor is intravenous drug abuse, which often includes other forms of substance abuse. It is important to understand posttransplant survival outcomes in patients with multiple substance abuse and pretransplant factors that predict relapse.
  
  
  METHODS
  The medical records of patients referred to the transplant psychiatrist were retrospectively reviewed to identify posttransplant patients with pretransplant multisubstance abuse issues including cannabis, cocaine, opioids, and alcohol. Survival outcomes and drug relapse were assessed in relation to demographic variables including age, race, sex, legal history, psychiatric diagnoses or need for psychiatric hospitalization, and substance abuse diagnosis.
  
  
  RESULTS
  Twenty-seven patients with polysubstance abuse disorders were identified: substance abuse (n=41), substance dependence (n=33), and other (n=8); a mean of 3.03 substances was used per patient. Eight patients relapsed (29.6%) and 10 patients died (33%) between 2 and 60 months after transplant. Patients were divided into relapse and no-relapse groups, and 1-year patient survival rates in patients were 100% and 83.9%, respectively. No between-group differences were found for age, race, sex, legal history, psychiatric diagnoses or need for psychiatric hospitalization, or having first-degree relatives with substance abuse issues.
  
  
  CONCLUSIONS
  The rate of recidivism was 26.9%; however, it did not affect survival. No predictors of relapse were identified. Patients with polysubstance abuse issues should not be categorically denied access to liver transplant. Further research regarding these issues is essential.
authors.affiliation: Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Nickels
authors.forename: Ashok
authors.initials: A
authors.lastname: Jain
authors.forename: Rajeev
authors.initials: R
authors.lastname: Sharma
authors.forename: Mark
authors.initials: M
authors.lastname: Orloff
authors.forename: Georgios
authors.initials: G
authors.lastname: Tsoulfas
authors.forename: Randeep
authors.initials: R
authors.lastname: Kashyap
authors.forename: Adel
authors.initials: A
authors.lastname: Bozorgzadeh
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000150:complications / Q000523:psychology; D005260:Female; D006085:Graft Survival / Q000187:drug effects*; D006801:Humans; D017093:Liver Failure / Q000209:etiology / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000150:complications* / Q000523:psychology