The DRAM, Vol. 4(7) – Relapse after an organ transplant


Long term alcohol abuse and or dependence can lead to organ disease, sometimes creating a need for organ transplant. Returning to substance use after a transplant increases the risk of medical complications and even death (e.g., Kran & DiMartini, 2005). Organs for transplant are scarce (Organ Procurement and Transplantation Network, 2008).  Some observers believe recipient prioritization should take alcohol use history into account.  This week we examine a meta-analysis to measure relapse among people who require organ transplants and have a history of alcohol misuse (Dew, DiMartini, Steel, De Vito Dabbs, Myaskovsky, et al., 2008).

Meta-analysis of 54 studies, included 3,651 participants and 13,821 person years of observation

Authors searched six databases (e.g., PsychInfo, MEDLINE) for studies addressing non-adherence to the medical regimen following organ transplantation

Inclusion criteria for studies

  • Written in English language
  • Published between 1981-2005
  • Did not use the same dataset as any other study
  • Sample size of 10 people or more
  • Indication that prior to transplant, participants had histories of substance abuse, dependence, or diseases that indicated these disorders
  • Includes substance use history, relapse, and treatment non-adherence behavior

Relapse to any alcohol use and to heavy alcohol use


Figure. Pooled estimates of post-transplantation rates of relapse to alcohol use (cases per 100 persons per year). Click image to enlarge.

  • Average number of observation years per study = 4 (SD=2.7, range=0.9-12.9)
  • The Q-statistic in the Figure indicates a wide range of relapse rates across studies
  • Risk for post-operative relapse higher for patients of hospitals that had no requirement for 6-month pre-operative sobriety (average effect size: r = .21 (95% CI 0.11-0.31) p<.01)


  • Retrospective self report methodology
  • No control group: unclear whether risk for post-operative drinking is greater among samples with an abuse history than other transplant populations

This study reminds us about the likelihood for relapse among transplant patients who had histories of alcohol abuse or dependence. Although popular opinion seems to lean towards sanctions on those with alcohol misuse histories, hospitals can use empirical evidence to guide careful selection of transplant candidates. This study’s results suggest one selection criteria could be a longer period of abstinence before the planned surgery.  Another guideline, not examined in this study, could be participation in substance abuse treatment before and after the surgery.

—Leslie Bosworth

What do you think? Please use the comment link below to provide feedback on this article.


Dew, M. A., DiMartini, A. F., Steel, J., De Vito Dabbs, A., Myaskovsky, L., Unruh, M., et al. (2008). Meta-analysis of risk for relapse to Substance use after transplantation of the liver or other solid organs. Liver Transplantation, 14, 159-172.

Kran, L. E., & DiMartini, A. (2005). Psychiatric and psychosocial aspects of liver transplantation. Liver Transplantation, 11, 1157-1168.

Organ Procurement and Transplantation Network. Data, View Data Reports, National Data. Retrieved June 4, 2008, from

One thought on “The DRAM, Vol. 4(7) – Relapse after an organ transplant

  1. Bob K Reply

    Hello Leslie,
    I just read the DRAM article “Relapse After an Organ Transplant” and had to share an incident from about ten years ago: I was trout fishing in the back country in Northeast Iowa (yes, Iowa has back country and trout streams!) when I blew a tire on a gravel road next to a farm field. While I got to work changing the tire, a farmer pulled up in his combine, got off the equipment with a cooler and asked if I needed help. I declined the help, but he stayed to chat and pulled a beer out of his cooler. He asked if I cared for a beer also and I declined. He shared that he was just out of Mayo after a liver transplant and said it was “sooo good to be able to drink again!” He chugged the beer and then opened a second beer. I asked if he wasn’t worried about ruining this liver also, and he responded that since the last liver lasted 45 years, he expected this liver to last another 45 years! I remember wondering if the medical staff Mayo had educated him about the danger of drinking again, particularly so soon after the transplant. Probably he had been using selective listening.
    I always enjoy reading the BASIS articles and often forward them on to our gambling and substance abuse treatment contractors.
    Best wishes,

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