Addictive behaviors in liver transplant recipients: The real problem?

Abstract

Liver transplantation (LT) is the gold standard treatment for end-stage liver disease. Whatever the primary indication of LT, substance abuse after surgery may decrease survival rates and quality of life. Prevalence of severe alcohol relapse is between 11 and 26%, and reduces life expectancy regardless of the primary indication of LT. Many patients on waiting lists for LT are smokers and this is a major risk factor for both malignant tumors and cardiovascular events post-surgery. The aim of this review is to describe psychoactive substance consumption after LT, and to assess the impact on liver transplant recipients. This review describes data about alcohol and illicit drug use by transplant recipients and suggests guidelines for behavior management after surgery. The presence of an addiction specialist in a LT team seems to be very important.

Keywords: Liver transplantation; Tobacco use; Illicit drugs; Behavior management; Severe alcohol relapse

Core tip: Liver transplantation is the best treatment for end-stage liver disease. However, some transplant recipients use or abuse alcohol, tobacco and illicit drugs during the post-transplant period. Given the scarcity of organs, this type of consumption, which can affect life expectancy and quality, must be addressed with kindness and without moralizing. Although specific behavior treatment does not exist in this indication, specialists in addiction should be part of the transplant team.