Liver transplantation and opioid dependence

Context Chronic hepatitis C is the leading cause for liver transplantation in the United States. Intravenous drug use, the major risk factor, accounts for approximately 60% of hepatitis C virus transmission. Information from the United Network of Organ Sharing (UNOS) does not address substance use a mong liver transplantation patients. Objective To identify addiction-related criteria for admission to the UNOS liver trans plantation waiting list and posttransplantation problems experi enced by patients who are prescribed maintenance methadone. Design, Setting, and Participants Mail survey of all 97 adult US liver tran splantation programs (belonging to UNOS) in March 2000 with telephone follo w-up conducted in May and June 2000. Main Outcome Measures Programs' acceptance and management of patients with past or present substance use disorder. Results Of the 97 programs surveyed, 87 (90%) responded. All accept applica nts with a history of alcoholism or other addictions, including heroin depe ndence. Eighty eight percent of the responding programs require at least 6 months of abstinence from alcohol; 83% from illicit drugs. Ninety-four perc ent have addiction treatment requirements. Consultations from substance abu se specialists are obtained by 86%. Patients receiving methadone maintenanc e are accepted by 56% of the responding programs. Approximately 180 patient s receiving methadone maintenance are reported to have undergone liver tran splantation. Conclusions Most liver transplantation programs have established policies f or patients with substance use disorders. Opiate-dependent patients receivi ng opiate replacement therapy seem underrepresented in transplantation prog rams. Little anecdotal evidence for negative impact of opiate replacement t herapy on liver transplantation outcome was found. Policies requiring disco ntinuation of methadone in 32% of all programs contradict the evidence base for efficacy of long-term replacement therapies and potentially result in relapse of previously stable patients.