Survival and Risk of Recidivism in Methadone-Dependent Patients Undergoing Liver Transplantation

Abstract

Cirrhosis resulting from hepatitis C virus is presently the most common indication for liver transplantation (OLT) in the United States. A number of U.S. transplant centers require cirrhotics who are using methadone to discontinue it before proceeding with OLT. We sought to examine the outcomes of those patients who had undergone OLT at the Mount Sinai Medical Center.A retrospective chart review of 36 subjects on methadone maintenance treatment (MMT), and off heroin, at the time of OLT was performed.The median daily methadone dose pre-OLT was 50 mg. Post-OLT, there was an increase in methadone dose in 15 subjects, a decrease in four subjects, and no dose change in 17 subjects. Four subjects had documented single episodes of intravenous drug use post-OLT; only one subject had a dose change after the event. Patient and graft survival rates were comparable to the national average.There was no significant difference in post-OLT outcome in patients on MMT when compared with the general population. The few episodes of drug relapse were not related to changes in the methadone dose. Efforts should be made to allow methadoneusing cirrhotics better access to OLT without regard to methadone dosage.

Psychiatric Care of Patients Undergoing Organ Transplantation

“…Selection standards vary as well in regard to advanced age, history of alcohol abuse, and body mass index (6 -9). Some centers do not accept patients on maintenance methadone although there are favorable reports for outcome and a small risk for relapse among recipients on chronic methadone maintenance after transplantation (10,11). There has been similar success among patients with manageable psychotic disorders (12).…”

Management of end stage liver disease (ESLD): What is the current role of orthotopic liver transplantation (OLT)?

“…alcohol). Patients who are on stable methadone maintenance programmes are not excluded from transplant and can continue on such programmes after the transplant [22]. Finally, HIV-infected patients must show an appropriate degree of social stability to ensure adequate care in the posttransplant period.…”

Liver Transplant—Psychiatric and Psychosocial Aspects

“…Studies have also shown that in general there is no difference in the MMT liver transplant recipients and general transplant population with regards to adherence to immunosuppressive medications and overall graft survival rates. 26,29,30 Hence such patients should be evaluated on a case to case basis and methadone can be safely continued in the post-transplant period in the usual doses. Those patients who are on stable adequate doses of methadone, follow other measures of MMT program and have excellent social support should be considered for liver transplant.…”