Departments of Psychiatry and Surgery, University of Michigan, Ann Arbor, MI, 48109, USA.
Department of Psychiatry, Columbia University Medical Center, 622 West 168th Street, PH14-105, New York, NY, 10032, USA.
Best Pract Res Clin Gastroenterol. 2020 Jun-Aug;46-47:101685. doi: 10.1016/j.bpg.2020.101685. Epub 2020 Sep 14.
In this article we tackle the controversial subject of alcohol and other substance use following liver transplantation (LT). Most of the literature on and importance of this topic pertains not to recreational use of alcohol or substances but to patients who have alcohol or substance use disorders (AUDs/SUDs). To understand these behaviors after such a lifesaving and resource-intensive procedure as LT necessitates an understanding of these disorders as chronic medical diseases. It also requires an awareness that management of these disorders begins before transplant, so we will briefly touch on considerations to prepare patients for the transplantation. Additionally, we review not only the rates of alcohol and substance use post-LT but strategies clinicians could adopt to identify and manage these events post-LT. Thus, we will summarize approaches for monitoring use and a range of therapeutic treatment options, including pharmacotherapy, to employ once use is discovered. While clinical gastroenterologists may be the primary clinicians responsible for the care of LT recipients, we emphasize a multidisciplinary team approach which, especially for the behavioral health components of the treatment, is likely to be the most successful. This article concludes with a summary of recommendations for clinicians working with these patients and possible future directions for both clinical care and research. While the bulk of the literature is on LT in the context of AUD, we review the smaller body of literature available on non-alcohol substance use.
在这篇文章中，我们探讨了肝移植（LT）后饮酒和其他物质使用的争议性问题。该主题的大部分文献和重要性都不是针对酒精或物质的娱乐性使用，而是针对患有酒精或物质使用障碍（AUD/SUD）的患者。要理解 LT 等拯救生命和资源密集型手术后的这些行为，就需要将这些疾病理解为慢性疾病。它还需要认识到，这些疾病的管理在移植前就已经开始，因此我们将简要讨论为患者准备移植的考虑因素。此外，我们不仅回顾了 LT 后酒精和物质使用的比率，还回顾了临床医生可以采用的策略，以识别和管理 LT 后这些事件。因此，我们将总结监测使用的方法和一系列治疗选择，包括药物治疗，一旦发现使用就可以采用这些方法。虽然临床胃肠病学家可能是 LT 受者护理的主要临床医生，但我们强调采用多学科团队方法，对于治疗的行为健康部分，这种方法可能是最成功的。本文最后总结了为这些患者提供服务的临床医生的建议，并为临床护理和研究提出了可能的未来方向。虽然大部分文献都是关于 AUD 背景下的 LT，但我们也回顾了关于非酒精物质使用的较少文献。
