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Majumder 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:e8986. [PMID: 32775068 PMCID: PMC7402423 DOI: 10.7759/cureus.8986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Solid-organ transplantation is one of the significant advances in the medical field that have improved the quality of life and survival rates of numerous patients with end-organ dysfunction. Substance use is a common condition of individuals who are in need of solid-organ transplantation. The implications of substance use on solid-organ transplants are gaining increasing attention over the past decade. The current review seeks to explore the prevalence rate of illicit substance use among those who receive solid-organ transplantation (pre and post-transplant) and whether illicit substance use before solid-organ transplantation affects the outcome of solid-organ transplants. We searched the Medline database for all the articles available in English on the prevalence of substance use in the context of solid-organ transplant and the effect on outcome measures. We found 21 relevant articles. It appears that substance use is fairly common among solid-organ transplant candidates, with cannabis being the most common substance of abuse. A heterogeneous sample precludes the drawing of a clear-cut conclusion. But it appears that substance use may affect various outcomes of solid-organ transplants. The existing literature may not be sufficient to adequately assess the risk but limited evidence indicates that illicit substance use, particularly cannabis use, may not affect the overall survival following a solid-organ transplant.
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Affiliation(s)
| | - Siddharth Sarkar
- Addiction, All India Institute of Medical Sciences, New Delhi, IND
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Reddy PKV, Ng TMH, Oh EE, Moady G, Elkayam U. Clinical Characteristics and Management of Methamphetamine-Associated Cardiomyopathy: State-of-the-Art Review. J Am Heart Assoc 2020; 9:e016704. [PMID: 32468897 PMCID: PMC7428977 DOI: 10.1161/jaha.120.016704] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Methamphetamine‐associated cardiomyopathy (MACM) is an increasingly recognized disease entity in the context of a rapidly spreading methamphetamine epidemic. MACM may afflict individuals with a wide range of ages and socioeconomic backgrounds. Presentations can vary greatly and may involve several complications unique to the disease. Given the public health significance of this disease, there is a relative dearth of consensus material to guide clinicians in understanding, diagnosing, and managing MACM. This review therefore aims to: (1) describe pathologic mechanisms of methamphetamine as they pertain to the development, progression, and prognosis of MACM, and the potential to recover cardiac function; (2) summarize existing data from epidemiologic studies and case series in an effort to improve recognition and diagnosis of the disease; (3) guide short‐ and long‐term management of MACM with special attention to expected or potential sequelae of the disease; and (4) highlight pivotal unanswered questions in need of urgent investigation from a public health perspective.
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Affiliation(s)
- Pavan K V Reddy
- Division of Cardiovascular Medicine Keck School of Medicine University of Southern California Los Angeles CA
| | - Tien M H Ng
- School of Pharmacy University of Southern California Los Angeles CA
| | - Esther E Oh
- School of Pharmacy University of Southern California Los Angeles CA
| | - Gassan Moady
- Division of Cardiovascular Medicine Keck School of Medicine University of Southern California Los Angeles CA
| | - Uri Elkayam
- Division of Cardiovascular Medicine Keck School of Medicine University of Southern California Los Angeles CA
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Luc JGY, Buchholz H, Kim DH, MacArthur RGG. Left ventricular assist device for ventricular recovery of anabolic steroid-induced cardiomyopathy. J Surg Case Rep 2018; 2018:rjy221. [PMID: 30151111 PMCID: PMC6101629 DOI: 10.1093/jscr/rjy221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 07/26/2018] [Indexed: 12/27/2022] Open
Abstract
Herein we report a case of a 26-year-old gentleman with severe cardiomyopathy likely secondary to anabolic-androgenic steroid (AAS) abuse who received a HeartMate II (Abbott Laboratories, Abbott Park, IL) left ventricular assist device (LVAD) for rapidly deteriorating heart failure with hemodynamic compromise. Following 18 months on LVAD support, excellent recovery of ventricular function was achieved to allow for LVAD discontinuation. Given that active substance abuse is a contraindication to heart transplantation, few options remain for patients with AAS induced heart failure. Our case demonstrates that LVAD therapy can be an important intervention for bridging to candidacy, recovery or destination therapy.
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Affiliation(s)
- Jessica G Y Luc
- Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
| | - Holger Buchholz
- Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
| | - Daniel H Kim
- Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada.,Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Roderick G G MacArthur
- Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
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Bui QM, Allen LA, Monte AA, Page RL, McIlvennan CK. Amphetamine-positive urine drug screens in the setting of mexiletine use: A case series. J Heart Lung Transplant 2016; 35:1045-8. [PMID: 27287628 DOI: 10.1016/j.healun.2016.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 05/04/2016] [Indexed: 11/28/2022] Open
Affiliation(s)
- Quan M Bui
- Division of Internal Medicine, University of California at San Diego, San Diego, California
| | - Larry A Allen
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Andrew A Monte
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Robert L Page
- University of Colorado Skaggs School of Pharmacy, Aurora, Colorado
| | - Colleen K McIlvennan
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
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Cogswell R, Smith E, Hamel A, Bauman L, Herr A, Duval S, John R, Roman D, Adatya S, Colvin-Adams M, Garry D, Martin C, Missov E, Pritzker M, Roberts J, Eckman P. Substance abuse at the time of left ventricular assist device implantation is associated with increased mortality. J Heart Lung Transplant 2014; 33:1048-55. [DOI: 10.1016/j.healun.2014.06.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 05/05/2014] [Accepted: 06/18/2014] [Indexed: 11/28/2022] Open
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Stilley CS, Flynn WB, Sereika SM, Stimer ED, DiMartini AF, deVera ME. Pathways of psychosocial factors, stress, and health outcomes after liver transplantation. Clin Transplant 2011; 26:216-22. [PMID: 21518004 DOI: 10.1111/j.1399-0012.2011.01467.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The impact of stress and individual factors on health outcomes in general medicine and transplantation are well documented. Few researchers have investigated the complex relationships between these constructs. This longitudinal study assessed coping style, self-regulatory ability, hostility, and social support at baseline among a cohort of 130 adult liver transplant recipients at the Starzl Transplant Institute, University of Pittsburgh Medical Center, and followed those subjects with interview and medical records data about personal and transplant-related stress, physical and mental health outcomes throughout the first post-transplant year. Results show a number of strong bidirectional relationships between coping style, self-regulatory ability, hostility, the caregiver relationship and family environment, personal and transplant-related stress over the second half of the first post-transplant year, and health (especially mental) outcomes at 12 months post-transplant. Stress mediates the relationship between psychosocial factors and mental health outcomes. The importance of those relationships to researchers and clinicians is discussed.
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Affiliation(s)
- Carol S Stilley
- University of Pittsburgh School of Nursing, Pittsburgh, PA, USA.
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Dew MA, DiMartini AF, Steel J, De Vito Dabbs A, Myaskovsky L, Unruh M, Greenhouse J. Meta-analysis of risk for relapse to substance use after transplantation of the liver or other solid organs. Liver Transpl 2008; 14:159-72. [PMID: 18236389 PMCID: PMC2883859 DOI: 10.1002/lt.21278] [Citation(s) in RCA: 187] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
For patients receiving liver or other organ transplants for diseases associated with substance use, risk for relapse posttransplantation is a prominent clinical concern. However, there is little consensus regarding either the prevalence or risk factors for relapse to alcohol or illicit drug use in these patients. Moreover, the evidence is inconsistent as to whether patients with pretransplantation substance use histories show poorer posttransplantation medical adherence. We conducted a meta-analysis of studies published between 1983 and 2005 to estimate relapse rates, rates of nonadherence to the medical regimen, and the association of potential risk factors with these rates. The analysis included 54 studies (50 liver, 3 kidney, and 1 heart). Average alcohol relapse rates (examined only in liver studies) were 5.6 cases per 100 patients per year (PPY) for relapse to any alcohol use and 2.5 cases per 100 PPY for relapse with heavy alcohol use. Illicit drug relapse averaged 3.7 cases per 100 PPY, with a significantly lower rate in liver vs. other recipients (1.9 vs. 6.1 cases). Average rates in other areas (tobacco use, immunosuppressant and clinic appointment nonadherence) were 2 to 10 cases per 100 PPY. Risk factors could be examined only for relapse to any alcohol use. Demographics and most pretransplantation characteristics showed little correlation with relapse. Poorer social support, family alcohol history, and pretransplantation abstinence of < or =6 months showed small but significant associations with relapse (r = 0.17-0.21). Future research should focus on improving the prediction of risk for substance use relapse, and on testing interventions to promote continued abstinence posttransplantation.
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Affiliation(s)
- Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
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Abstract
Effective physicians recognize that most patients have difficulty following instructions for a variety of reasons. That difficulty is best understood as nonadherence rather than noncompliance. The surgeon's role is to make the patient's choice informed, to be aware of the risk factors for nonadherence, and not to make adherence any more difficult than it has to be. The patient's role is to make choices between value-laden alternatives. Society's role is to distribute scarce medical resources equitably to patients who can and want to adhere to the necessary regimen to benefit from them.
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Affiliation(s)
- Jay A Jacobson
- Division of Medical Ethics, Department of Internal Medicine, LDS Hospital and University of Utah School of Medicine, Salt Lake City, UT 84143, USA.
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Fierz K, Steiger J, Denhaerynck K, Dobbels F, Bock A, De Geest S. Prevalence, severity and correlates of alcohol use in adult renal transplant recipients. Clin Transplant 2006; 20:171-8. [PMID: 16640523 DOI: 10.1111/j.1399-0012.2005.00460.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Severe alcohol use is recognized as a major public health concern, even though light to moderate alcohol use might have beneficial effects on health. Alcohol use has been studied to some extent in solid organ transplant populations, yet evidence is lacking on alcohol use and its correlates in the renal transplant population. The aim of this study was therefore to determine the prevalence, severity and correlates of alcohol use in renal transplant recipients. METHODS This cross-sectional study is a secondary analysis of the Supporting Medication Adherence in Renal Transplantation (SMART) study. Alcohol use was assessed by patient's self-report. At risk and binge drinkers were classified using World Health Organization criteria. The following correlates of alcohol use were explored: adherence with immunosuppression (Siegal questionnaire; electronic monitoring), smoking, coping style (UCL), depressive symptomatology (BDI) and busyness/routine in life style (ACQ Busyness Scale). RESULTS Two hundred and eighty-four patients were included in this analysis, 58.1% male, with a mean age of 54 yr (range 20-84) and a median of seven (interquartile ranges [IQR] 8) yr post-transplantation. A total of 52.8% of study participants reported to drink alcohol at least once a week. Two hundred and eighty of 284 subjects (98.5%) were drinking at low risk, four at moderate risk (1.5%). None of the participants were drinking severely. Correlates of alcohol use were male gender and being professionally active. CONCLUSION Alcohol use is less prevalent in renal transplant recipients than in the general population. Severe alcohol use does not seem to represent a serious problem in renal transplant patients.
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Affiliation(s)
- Katharina Fierz
- Institute of Nursing Science, University of Basel, Basel, Switzerland
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Jacobson JA. The effect of patients' noncompliance on their surgeons' obligations. Thorac Surg Clin 2005; 15:461-8. [PMID: 16276810 DOI: 10.1016/j.thorsurg.2005.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Professional oaths and codes do not establish a firm basis for the obligation to treat all patients and they provide little or no clear guidance about whether patient nonadherence exempts a physician from a longstanding and still prevalent tradition in surgery supports a strong obligation to one's established patients. A personal belief in an obligation to serve those less fortunate or even less compliant could support sustained treatment and special assistance to a nonadherent patient. A collective, professional, objective, informed decision to exclude a patient who is highly likely to be nonadherent or incapable of adherence from the benefit of a scarce resource, such as a human organ, is defensible and appropriate. A surgeon's decision to deny care to an established but nonadherent patient is much less so. Adherence is as dependent on physician attitude, skill, and behavior as it is on patients' nonadherence. To the degree that it reflects less than competent management of this prevalent problem, it can be considered an error or complication that makes most surgeons feel even more obliged to mitigate or rectify the problem. This article describes the almost ubiquitous phenomenon of nonadherence; a way to reconceptualize noncompliance; and practical steps that can help predict, prevent, identify, and manage it. It is hoped that this helps surgeons reduce the frequency of nonadherence, make dealing with it less onerous, and consequently achieve better outcomes. It is reasonable to think about nonadherence in terms of three roles. The surgeon's role is to make the patient's choice informed, to be aware of the risk factors for nonadherence, and not make adherence any more difficult than it has to be. The patient's role is to make choices between value-laden alternatives. Society's role is equitably to distribute scarce medical resources to patients who can and want to adhere to the necessary regimen to benefit from them.
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Affiliation(s)
- Jay A Jacobson
- Division of Medical Ethics, Department of Internal Medicine, LDS Hospital and University of Utah School of Medicine, Salt Lake City, UT 84143, USA.
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