Integration of an Addiction Team in a Liver Transplantation Center
Integration of an Addiction Team in a Liver Transplantation Center
复制标题
DOI：
10.1002/lt.25641
复制
发表时间：
2019-10-11
影响因子：
4.6
通讯作者：
Pageaux, Georges-Philippe
中科院分区：
文献类型：
--
作者：
Donnadieu-Rigole, Helene;Jaubert, Laura;Pageaux, Georges-Philippe
高达 50% 的肝移植 (LT) 受者在手术前患有已知或秘密酒精使用障碍 (AUD)，在 LT 后恢复饮酒。然而，只有严重的酒精复发（其频率从 11% 到 26% 的患者不等）才会对长期生存产生影响，并显着降低 10 年后的生存率。因此，确定严重复发风险最高的患者至关重要，以便在 LT 前后安排成瘾小组进行具体、标准化的监测。本研究的目的是描述 AUD 联合治疗对严重酒精复发率的影响，并确定 LT 前预测严重酒精复发的危险因素。该研究纳入了 2008 年 1 月至 2014 年 12 月期间接受移植并与 LT 团队的成瘾专家会面的患者。表现出与酒精相关的复发危险因素的患者接受了特定的成瘾随访。共有 235 名患者参加了该研究。其中大多数是男性 (79%)，LT 时的平均年龄为 55.7 岁。只有 9% 的移植受者出现严重复发。严重复发的与酒精相关的因素是移植前 6 个月的戒酒以及饮酒对家庭、法律或职业造成的后果，而非酒精相关的因素是单身且有资格领取残疾养老金。总之，将成瘾团队纳入 LT 中心可能是有益的。成瘾专家可以在移植前识别出有严重复发风险的患者，从而安排具体的随访。
Up to 50% of liver transplantation (LT) recipients with known or clandestine alcohol-use disorder (AUD) before surgery return to alcohol use after LT. However, only severe alcohol relapse, which varies in frequency from 11% to 26% of patients, has an impact on longterm survival and significantly decreases survival rates after 10 years. Therefore, it is crucial to identify patients with the highest risk of severe relapse in order to arrange specific, standardized monitoring by an addiction team before and after LT. The aims of this study were to describe the effects of combined management of AUD on the rate of severe alcohol relapse and to determine the risk factors before LT that predict severe relapse. Patients transplanted between January 2008 and December 2014 who had met with the LT team's addiction specialist were included in the study. Patients who exhibited alcohol-related relapse risk factors received specific addiction follow-up. A total of 235 patients were enrolled in the study. Most of them were men (79%), and the mean age at the time of the LT was 55.7 years. Severe relapse occurred in only 9% of the transplant recipients. Alcohol-related factors of severe relapse were a pretransplant abstinence of 6 months and family, legal, or professional consequences of alcohol consumption, whereas the nonalcohol-related factors were being single and being eligible for a disability pension. In conclusion, the integration of an addiction team in a LT center may be beneficial. The addiction specialist can identify patients at risk of severe relapse in the pretransplantation period and hence arrange for specific follow-up.