Mental health and chemical dependency services at US transplant centers

Niazi, Shehzad K.; Spaulding, Aaron; Vargas, Emily; Schneekloth, Terry D.; Crook, Julia E.; Rummans, Teresa A.; Taner, C. Burcin

doi:10.1111/ajt.15659

Cited by 8 publications

(5 citation statements)

References 39 publications

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“…In the real world, mental health services are typically provided as consultation services during the LT evaluation and the candidate selection process, and not during the waiting period in the follow-up period after LT. A recent survey of mental health and addiction services at nonfederal LT programs in the United States showed that while 94% of the programs offered mental health services, only 47% offered chemical dependency services and only 47% had access to their medical system. [105] Far fewer LT programs have addiction services colocated in an integrated clinic. However, for patients at risk for alcohol use recurrence, an inpatient program with detoxification may be necessary before being transitioned to an outpatient program.…”

Section: Aud Treatment In Patients With Ald: the Ground Realitymentioning

confidence: 99%

Alcohol use disorder in alcohol-associated liver disease: Two sides of the same coin

Singal,

Leggio,

DiMartini

2023

Liver Transplantation

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Alcohol-associated liver disease (ALD) has emerged as the leading indication for liver transplantation (LT) worldwide, with 40% of LTs in the United States performed for ALD in 2019. The ALD-related health care burden accelerated during the COVID-19 pandemic, especially in young individuals. Alcohol use disorder (AUD), which focuses on the negative effects of alcohol on psychosocial, physical, and mental health, is present in the majority of patients with ALD, with moderate to severe AUD in 75%–80%. During the last decade, early liver transplantation (eLT) has emerged as a lifesaving treatment for selected patients with alcohol-associated hepatitis; these patients may have a higher risk of using alcohol after LT. The risk of alcohol use recurrence may be reduced during the pretransplant or post-transplant period with AUD treatment using behavioral and/or pharmacological therapies and with regular monitoring for alcohol use (self-reported and complemented with biomarkers like phosphatidylethanol). However, AUD treatment in patients with ALD is challenging due to patient, clinician, and system barriers. An integrated model to provide AUD and ALD care by hepatologists and addiction experts in a colocated clinic starting from LT evaluation and selection to monitoring listed candidates and then to following up on recipients of LT should be promoted. However, the integration of addiction and hepatology teams in an LT program in the real world is often present only during evaluation and candidate selection for LT. Data are emerging to show that a multidisciplinary integrated AUD treatment within an LT program reduces recurrent alcohol use after LT. If we want to continue using early liver transplantation for patients with severe alcohol-associated hepatitis, LT programs should focus on building integrated multidisciplinary care teams for the integrated treatment of both AUD and ALD.

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Section: Aud Treatment In Patients With Ald: the Ground Realitymentioning

confidence: 99%

Alcohol use disorder in alcohol-associated liver disease: Two sides of the same coin

Singal,

Leggio,

DiMartini

2023

Liver Transplantation

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“…Including social workers in HCT interventions may reduce barriers by providing improved linkages to health care and community-based services as well as greater psychosocial support leading to sustainable positive health outcomes (43). Prior studies have demonstrated that increased social work support services are associated with lower total hospital costs and increased probability of physician follow-up (44,45).…”

Section: Social Workersmentioning

confidence: 99%

Health Care Transition for Adolescents and Young Adults With Pediatric‐Onset Liver Disease and Transplantation

Vittorio

Kosmach‐Park

King

et al. 2022

J. pediatr. gastroenterol. nutr.

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Advances in medical therapies and liver transplantation have resulted in a greater number of pediatric patients reaching young adulthood. However, there is an increased risk for medical complications and morbidity surrounding transfer from pediatric to adult hepatology and transplant services. Health care transition (HCT) is the process of moving from a child/family-centered model of care to an adult or patient-centered model of health care. Successful HCT requires a partnership between pediatric and adult providers across all disciplines resulting in a transition process that does not end at the time of transfer but continues throughout early adulthood. Joint consensus guidelines in collaboration with the American Society of Transplantation are presented to facilitate the adoption of a structured, multidisciplinary approach to transition planning utilizing The Six Core Elements of Health Care TransitionTM for use by both pediatric and adult specialists. This paper provides guidance and seeks support for the implementation of an HCT program which spans across both pediatric and adult hepatology and transplant centers.

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“…Although some studies have shown that pretransplantation anxiety was not associated with graft failure or increased mortality [28], there are data to support that lifetime exposure to traumatic events increases morbidity and mortality risks in the transplant population [18,36]. PTSD is more common among transplant candidates and recipients than in the general population [37]. Overall, across all organ types, an estimated 12–18% of transplant recipients develop PTSD because of their transplant experience [38 ▪ ].…”

Section: Psychosocial Perspectivementioning

confidence: 99%

Psychosocial considerations in the combined bariatric surgery and organ transplantation population: a review of the overlapping pathologies and outcomes

Fipps¹,

Sinha

Diwan

et al. 2022

Current Opinion in Organ Transplantation

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Purpose of reviewThis review highlights the salient data of the psychosocial concerns that influence outcomes of bariatric surgery and organ transplantation.Recent findingsBariatric surgery has emerged as an important intervention with data supporting substantial and sustained weight loss, enhanced quality of life, remission of obesity-related medical comorbidities, and improved long-term patient and graft survival in transplant patients. Depression, suicide, anxiety, posttraumatic stress disorder, alcohol use, adherence, and psychopharmacology considerations can influence outcomes of both these surgeries.SummaryObesity is increasingly prevalent among patients pursuing transplantation surgery, and it is often a factor in why a patient needs a transplant. However, obesity can be a barrier to receiving a transplant, with many centers implementing BMI criteria for surgery. Furthermore, obesity and obesity-related comorbidities after transplant can cause poor outcomes. In this context, many transplant centers have created programs that incorporate interventions (such as bariatric surgery) that target obesity in transplant candidates. A presurgery psychosocial assessment is an integral (and required) part of the process towards receiving a bariatric surgery and/or a transplantation surgery. When conducting a dual (bariatric and transplantation surgery) psychosocial assessment, it is prudent to understand the overlap and differentiation of specific psychosocial components that influence outcomes in these procedures.

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Mental health and chemical dependency services at US transplant centers

Cited by 8 publications

References 39 publications

Alcohol use disorder in alcohol-associated liver disease: Two sides of the same coin

Alcohol use disorder in alcohol-associated liver disease: Two sides of the same coin

Health Care Transition for Adolescents and Young Adults With Pediatric‐Onset Liver Disease and Transplantation

Psychosocial considerations in the combined bariatric surgery and organ transplantation population: a review of the overlapping pathologies and outcomes

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