Correlates and outcomes of alcohol use after single solid organ transplantation: A systematic review and meta-analysis

Abstract

Background: Reviews on alcohol use in transplant recipients focus on liver recipients and their risk of post-transplant rejection, but do not assess alcohol use in kidney, heart, or lung transplant recipients. This systematic review and meta-analysis aims to synthesize the evidence on correlates and outcomes of any alcohol use and at-risk drinking after solid organ transplantation (Tx). Methods: We searched 4 databases for quantitative studies in adult heart, liver, kidney and lung Tx recipients, investigating associations between post-Tx alcohol use and correlates and/or clinical, economic or quality of life outcomes. Paper selection, data extraction and quality assessment were performed by 2 reviewers independently. A pooled odds ratio (OR) was computed for each correlate/outcome reported ≥ 5 times. Results: Of the 5,331 studies identified, 76 were included in this systematic review (93.3% on liver Tx; mean sample size 148.9 (SD= 160.2); 71.9% male; mean age 48.9 years (SD= 6.5); mean time post-Tx 57.7 months (SD= 23.1)). On average, 23.6% of patients studied used alcohol post-transplant. Ninety-three correlates of any post-Tx alcohol use were identified, and 9 of the 19 pooled ORs were significantly associated with a higher odds for any post-Tx alcohol use: male gender, being employed post-transplant, smoking pre-transplant, smoking post-transplant, a history of illicit drug use, having first-degree relatives who have alcohol-related problems, sobriety < 6 months prior to transplant, a history of psychiatric illness, and having received treatment for alcohol-related problems pre-transplant. On average 15.1% of patients had at-risk drinking. A pooled OR was calculated for 6 of the 47 correlates of post-Tx at risk drinking investigated, of which pre-transplant smoking was the only correlate being significantly associated with 2 this behavior. None of the outcomes investigated were significantly associated with any use or at-risk drinking. Conclusion: Correlates of alcohol use remain under-investigated in solid organ transplant recipients other than liver transplantation. Further research is needed to determine whether any alcohol use or atrisk drinking is associated with poorer post-transplant outcomes. Our meta-analysis highlights avenues for future research of higher methodological quality and improved clinical care.

How to screen for at‐risk alcohol use in transplant patients? From instrument selection to implementation of the AUDIT‐C

“…This proportion is five times higher than the 6% reported in the report of the National Health Survey of Belgium, 35 yet the latter used different questions. The percentage observed within our heart transplant program is also twice as high as the 15% at‐risk drinking reported in a recently published meta‐analysis in solid organ transplantation 36 . Yet, studies almost exclusively focused on liver transplant patients, a population known to include a significant portion of patients with a history of alcohol‐related problems who are closely monitored to prevent alcohol use relapse post‐transplant.…”

“…at-risk drinking reported in a recently published meta-analysis in solid organ transplantation. 36 in liver transplant candidates, and that its presence often remains unnoticed without formal assessment. We will explore whether the AUDIT-C can be used successfully in transplant candidates also.…”

“…The percentage observed within our heart transplant program is also twice as high as the 15% at-risk drinking reported in a recently published meta-analysis in solid organ transplantation. 36 transplantation. In any case, the high prevalence observed in our heart transplant population flags a need for supportive interventions.…”

Prospective single-centre clinical observational study on electronically monitored medication non-adherence, its psychosocial risk factors and lifestyle behaviours after heart transplantation: a study protocol

“… 33 Smoking in turn was found to be a risk factor for post-transplant at-risk drinking, while post-transplant alcohol use in general could be linked with male gender, being employed, and a history of psychiatric illness, among others. 35 No significant risk factors were found for low physical exercise. 36 Most of these studies are based on the results of kidney recipients, while research on heart recipients is rare.…”

A Secondary Analysis from The International BRIGHT Study For Gender Differences In Adherence To Nonpharmacological Health-Related Behaviors After Heart Transplantation

“…8 Emerging literature has shown that nonadherence to nonpharmacological health-related behaviors posttransplant, negatively impacts morbidity and mortality and the determinants of behaviors. [9][10][11][12][13][14][15][16][17][18][19] According to the International Society for Heart and Lung Transplantation's (ISHLT) registry the median survival, conditional on survival to 1 year, for adult recipients overall, is 13.9 years with females surviving longer than males, 14.8 years versus 13.6 years, respectively. 16 A large cohort study of heart recipients reported that females were less likely to have diabetes mellitus, hypertension, peripheral vascular disease, tobacco use, prior cardiovascular surgery and were less supported by an intra-aortic balloon pump or durable ventricular assist device than males but were more likely to have a history of malignancy or require intravenous inotropes.…”