Monnin Kara, Lofton Amie M, Naclerio Catherine, Buchanan Cindy L, Campbell Kristen, Tenenbaum Rachel B, Steinberg Christofferson Elizabeth
Pediatric Mental Health Institute, Children's Hospital Colorado, Aurora, CO, USA.
Integrated Care Division, Department of Behavioral Health, Kaiser Permanente, Lafayette, CO, USA.
Pediatr Transplant. 2021 Jun;25(4):e13984. doi: 10.1111/petr.13984. Epub 2021 Feb 12.
Psychosocial risk factors, such as substance use, have been linked to poor post-transplant outcomes for solid organ transplant patients, including poor medication adherence, increased risk for rejection, and even graft failure. Despite universal consensus that substance use is an increasing problem among youth, many pediatric transplant centers do not have policies in place to address substance use and no universal guidelines exist regarding assessment during the pre-transplant evaluation in this population. An online survey was administered via REDCap™ and directed toward medical leaders (ie, medical and surgical directors) of national heart, kidney, and liver transplant centers. Questions examined the following: perspectives on the need for a universal transplant center policy on pediatric substance use, abuse, and dependence; timing and frequency of evaluation for substance use; specific substances which would elicit respondents' concerns; and ethical concerns surrounding substance use. Data were analyzed using descriptive statistics. Data were collected from 52 respondents from 38 transplant centers, with the majority (n = 40; 77%) reporting no substance use policy in place for pediatric transplant patients. However, many endorsed concerns if a pediatric patient was found to be using specific substances. Our findings further highlight the need for a universal substance use policy across pediatric solid organ transplant centers. The results from the distributed survey will help to provide guidelines and best practices when establishing a universal policy for substance use.
社会心理风险因素，如药物使用，已被证明与实体器官移植患者移植后的不良预后有关，包括用药依从性差、排斥风险增加，甚至移植失败。尽管人们普遍认为药物使用在青少年中是一个日益严重的问题，但许多儿科移植中心并未制定相关政策来解决药物使用问题，而且在对这一人群进行移植前评估时，也没有关于评估的通用指南。通过REDCap™进行了一项在线调查，调查对象是全国心脏、肾脏和肝脏移植中心的医学负责人（即内科和外科主任）。问题包括：对制定关于儿科药物使用、滥用和依赖的通用移植中心政策的必要性的看法；药物使用评估的时间和频率；会引起受访者关注的特定药物；以及围绕药物使用的伦理问题。使用描述性统计方法对数据进行了分析。从38个移植中心的52名受访者那里收集了数据，大多数（n = 40；77%）报告称没有针对儿科移植患者的药物使用政策。然而，如果发现儿科患者使用特定药物，许多人表示担忧。我们的研究结果进一步凸显了在儿科实体器官移植中心制定通用药物使用政策的必要性。所开展调查的结果将有助于在制定通用药物使用政策时提供指导方针和最佳实践。
