643 - Substance Use Patterns in Pediatric Solid Organ Transplant Candidates: Impact after Transplant

Publication Number: 643.6822

Daniel S. Thomson, University of Colorado School of Medicine, Denver, CO, United States; Anna Dammann, Children’s Hospital Colorado, Denver, CO, United States; Elizabeth S. Christofferson, University of Colorado School of Medicine, Aurora, CO, United States; Margret Bock, University of Colorado School of Medicine, Aurora, CO, United States

Background: The prevalence and impact of substance use in pediatric solid organ transplant (pSOT) candidates and how these may relate to post-transplant outcomes is poorly studied.

Objective: In this retrospective study, we aimed to identify patterns of substance use among pSOT candidates and assess associations between pre-transplant substance use patterns and post-transplant patient and allograft outcomes.

Design/Methods: 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 (mean age= 15.5 years, 52% female) underwent KSADS testing at evaluation, subsequently received a transplant, and had 1 year of follow-up data available. Time-weighted coefficient of variance (CoV) in tacrolimus levels (previously shown to correlate with non-adherence) were calculated for all pSOT recipients during the follow-up period using 6 serum tacrolimus trough levels beginning 3 months post-transplant once stable trough goals were achieved. Episodes of biopsy-proven rejection for heart and kidney transplants, and clinically treated rejection episodes for liver transplants, were obtained via chart review.

Results: A total of 9 patients (16%) endorsed ever trying any substance at time of evaluation. Past and present substance use impairment symptoms based on DSM 5 substance use impairment criteria (e.g. substance withdrawal, substance craving, negative impact on relationships, etc.) pre-transplant were significantly associated with time-weighted CoV (past: r = .37, p = .006; present: r = .39, p = .003) in tacrolimus levels post-transplant. Past substance use impairment symptoms pre-transplant were associated with at least one rejection episode within one-year post-transplant (r = .32, p = .034). For patients who endorsed ever trying any substance, or for patients who endorsed trying any substance 5+ times, there were no significant differences for either group in adherence or rejection episodes when compared to patients who had never tried any substance.

Conclusion(s): While rates of substance use are low in this population of pSOT candidates, substance use impairment symptoms identified pre-transplant are associated with increased rejection episodes and surrogate markers for non-adherence post-transplant. Identification of pSOT candidates at risk for substance use disorders during evaluation and subsequent therapeutic interventions may be important to improve patient and allograft survival in pSOT recipients.

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