Liver transplantation for patients on methadone maintenance
Liver transplantation for patients on methadone maintenance
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DOI：
10.1053/jlts.2002.33976
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发表时间：
2002-09-01
影响因子：
4.6
通讯作者：
Rothstein, KD
中科院分区：
文献类型：
--
作者：
Kanchana, TP;Kaul, V;Rothstein, KD
大多数移植计划要求在原位肝移植(OLT)前至少6个月戒酒和服用违禁药物。然而，目前还没有关于正在接受美沙酮维持治疗(MMT)的患者的OLT结果的公开数据，MMT是在OLT时作为海洛因成瘾治疗的一部分。这项研究的目的是评估我们在终末期肝病(ESLD)患者接受原位肝移植时接受原位肝移植的经验。1993年3月至1999年5月，共有185例ESLD患者在本中心接受了原位肝移植。5名移植受者(2.7%)有海洛因滥用史，并接受过药物和酒精康复，但无法摆脱美沙酮。详细分析了这些患者的肝移植前状态、用药史、围手术期、药物治疗依从性、术后随访以及患者和同种异体移植物的存活率。所有服用MMT的患者均顺利接受了原位肝移植。他们的服药依从性和随访情况都很好。1例患者在原位肝移植后完全脱离美沙酮。本组患者术后平均住院时间为43+/-25天。虽然患者的数量很少，但接受MMT的肝移植受者的长期结果似乎与在此期间接受OLT的非MMT患者相似。我们的结果表明，如果服用MMT的肝硬变患者符合与酗酒患者相同的心理社会要求，则应考虑接受OLT。此外，患者在原位肝移植前不一定要撤除美沙酮。
Most transplant programs require abstinence of at least 6 months from alcohol and illicit drugs before orthotopic liver transplantation (OLT). However, there are no published data regarding OLT outcomes in patients who are currently on methadone maintenance treatment (MMT) as part of the treatment of their heroin addiction at the time of OLT. The objective of this study is to evaluate our experience regarding the outcome of OLT in patients with end-stage liver disease (ESLD) who were on MMT at the time of OLT. Between March 1993 and May 1999, a total of 185 patients with ESLD underwent OLT at our center. Five transplant recipients (2.7%) had a history of heroin abuse and had undergone drug and alcohol rehabilitation, but could not be weaned off methadone. Pre-OLT status, drug history, perioperative course, compliance with medical therapy, post-OLT follow-up, and patient and allograft survival were analyzed in detail in these patients. All patients on MMT underwent uneventful OLTs. Their compliance with medications and follow-up was excellent. One patient was weaned completely off methadone after OLT. Post-OLT mean hospital stay in this group was 43 +/- 25 days. Although the number of patients was small, long-term outcome of liver transplant recipients on MMT appears similar to that of patients not on MMT who underwent OLT during this period. Our results suggest cirrhotic patients on MMT should be considered for OLT if they meet the same psychosocial requirements as patients with alcohol abuse. Furthermore, it is not necessary for patients to be weaned off methadone before OLT.