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

BACKGROUND: 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. 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 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. RESULTS: 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. CONCLUSION: 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.