Academic Centre for Nursing and Midwifery KU, Leuven, Belgium; Institute of Nursing Science, Department of Public Health, University of Basel, Switzerland.
Institute of Nursing Science, Department of Public Health, University of Basel, Switzerland.
Transplant Rev (Orlando). 2019 Jan;33(1):17-28. doi: 10.1016/j.trre.2018.09.003. Epub 2018 Sep 28.
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).
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.
Of the 5331 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 this behavior. None of the outcomes investigated were significantly associated with any use or at-risk drinking.
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 at-risk drinking is associated with poorer post-transplant outcomes. Our meta-analysis highlights avenues for future research of higher methodological quality and improved clinical care.
PROSPERO protocol CRD42015003333.
关于移植受者饮酒的综述主要集中在肝移植受者及其发生移植后排斥反应的风险上，但并未评估肾、心或肺移植受者的饮酒情况。本系统评价和荟萃分析旨在综合评估实体器官移植（Tx）后任何饮酒和高危饮酒的相关性和结局。
我们在 4 个数据库中检索了成人心脏、肝脏、肾脏和肺 Tx 受者的定量研究，以调查 Tx 后饮酒与相关性以及/或临床、经济或生活质量结局之间的关系。由 2 名评审员独立进行论文选择、数据提取和质量评估。对报告≥5 次的每个相关性/结局计算合并比值比（OR）。
在确定的 5331 项研究中，有 76 项被纳入本系统评价（93.3%为肝 Tx；平均样本量为 148.9（SD=160.2）；71.9%为男性；平均年龄为 48.9（SD=6.5）岁；平均 Tx 后时间为 57.7（SD=23.1）个月）。平均而言，23.6%的研究患者在移植后饮酒。确定了 93 个与任何 Tx 后饮酒相关的因素，在 19 个合并 OR 中，有 9 个与更高的 Tx 后任何饮酒几率显著相关：男性、移植后就业、移植前吸烟、移植后吸烟、使用非法药物史、一级亲属有与酒精相关的问题、移植前戒酒时间<6 个月、既往精神病史和 Tx 前接受过酒精相关问题的治疗。平均 15.1%的患者存在高危饮酒行为。对 47 个与 Tx 后高危饮酒相关的因素中的 6 个计算了合并 OR，其中移植前吸烟是唯一与该行为显著相关的因素。没有任何研究结局与任何饮酒或高危饮酒显著相关。
除肝移植外，其他实体器官移植受者的饮酒相关性研究仍不足。需要进一步研究以确定任何饮酒或高危饮酒是否与移植后结局较差有关。我们的荟萃分析强调了未来研究的方向，即提高方法学质量和改善临床护理。
PROSPERO 方案 CRD42015003333。
