Methadone maintenance and chronic opioid analgesia in liver transplantation

Purpose of review: This review examines the issues surrounding the chronic use of opioids, both for treatment of opioid addiction and for pain management, in liver transplant patients. It examines the rationale for methadone maintenance treatment of opioid addiction and covers the growing evidence base supporting transplant in methadone-treated transplant candidates. It also raises pertinent concerns for consideration during the transplant assessment of patients on chronic opioid analgesia, including non-addicted, opioid addicted, and alcoholic transplant candidates. Recent findings: Two retrospective studies and one prospective study examine liver transplant outcomes in patients with opioid dependence on methadone maintenance therapy. Although limited in scope, they uniformly recommend consideration of patients in this group for liver transplantation. Methadone maintenance patients with hepatitis C virus are identified as an underrepresented group in liver transplantation programs with relatively recent exclusion from candidacy in some programs. Opioid analgesia for chronic pain in liver transplant patients is associated with several potential problems, especially in those with substance-abuse histories. Summary: This review highlights the rationale for methadone treatment of opioid dependence and the emerging research supporting liver transplantation in this patient population. It suggests cautious use of chronic opioid analgesia in transplant candidates, especially those with a history of addiction.