Substance Abuse

The clinician should obtain a detailed history of a patient's use of alcohol, recreational drugs, and tobacco in a pretransplant psychosocial evaluation for the purposes of assessing the potential toxic effects of these substances before transplantation and evaluating their potential impact on medication adherence following transplantation. A retrospective study of pediatric liver transplant recipients revealed a strong correlation between history of substance abuse and poorer treatment adherence (Lurie et al. 2000). In addition, parental history of substance use should be carefully assessed, because recent studies have suggested that this may impact the ability of the family to adequately supervise the posttrans-plant treatment regimen for the child (Fung and Shaw 2008).

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