Meta-analysis of risk for relapse to substance use after transplantation of the liver or other solid organs
Meta-analysis of risk for relapse to substance use after transplantation of the liver or other solid organs
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DOI：
10.1002/lt.21278
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发表时间：
2008-02-01
影响因子：
4.6
通讯作者：
Greenhouse, Joel
中科院分区：
文献类型：
--
作者：
Dew, Mary Amanda;DiMartini, Andrea F.;Greenhouse, Joel
对于因药物使用相关疾病而接受肝脏或其他器官移植的患者，移植后复发的风险是一个突出的临床问题。然而，对于这些患者复发酒精或非法药物的患病率或危险因素，几乎没有共识。此外，对于有移植前药物使用史的患者是否表现出较差的移植后医疗依从性，证据并不一致。我们对1983年至2005年间发表的研究进行了荟萃分析，以估计复发率、不遵守医疗方案的比率以及潜在危险因素与这些比率的关系。该分析包括54项研究（50项肝脏，3项肾脏和1项心脏）。平均酒精复发率（仅在肝脏研究中检查），任何酒精使用的复发为每年每100名患者（PPY） 5.6例，重度酒精使用的复发为每100名患者2.5例。平均每100名PPY中有3.7例非法药物复发，肝脏的复发率明显低于其他受体（1.9例对6.1例）。在其他领域（烟草使用、免疫抑制剂和门诊预约不依从）的平均比率为每100个PPY 2至10例。风险因素只能在任何酒精使用的复发时进行检查。人口统计学和大多数移植前特征与复发的相关性很小。较差的社会支持，家族酗酒史，移植前戒酒
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