Substance Use Patterns in Pediatric Solid Organ Transplant Candidates: Impact After Transplant

The prevalence and impact of substance use in pediatric solid organ transplant candidates and how these relate to post-transplant outcomes are not well studied.

The Alcohol and Substance Use modules of the Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS) were administered to all patients aged 12-18 who underwent heart, liver, or kidney transplant evaluation at our institution between 6/2020 and 12/2023. A total of 55 patients underwent KSADS testing at evaluation, received a transplant, and had adequate follow-up for inclusion. Following transplant, outcome measures included time-weighted coefficient of variance (TW-CoV) in serum tacrolimus level and organ rejection during follow-up.

A total of 9 patients (16%) endorsed ever trying any substance at time of pre-transplant evaluation. Past and present substance use impairment symptoms based on DSM-5 substance use impairment criteria pre-transplant were significantly associated with TW-CoV (past: r = 0.37, p = 0.006; present: r = 0.39, p = 0.003) in tacrolimus levels post-transplant. Past substance use impairment symptoms pre-transplant were associated with organ rejection by 1 year post-transplant (r = 0.32, p = 0.034). For patients who endorsed ever trying any substance, or trying any substance 5+ times, there were no significant differences for either group in adherence or rejection episodes when compared to patients who reported never trying any substance.

Rates of substance use are relatively low in this population of pediatric solid organ transplant candidates. Substance use impairment symptoms identified pre-transplant are associated with increased rejection episodes and surrogate markers for non-adherence post-transplant.