Methadone and lung transplants.

OBJECTIVES The aim of this article is to better understand the role of the liaison psychiatrist regarding the pulmonary pre-transplantation assessment for a patient treated by methadone. METHOD At the beginning, we collected data concerning the different habits of patients requiring pulmonary transplantation. Through a literature review, we studied the possible guidelines related to this subject, the effects of methadone, the side-effects explaining the psychiatrist's concerns. Finally, this problem is involved in the bio-psycho-social model to underline the influence of methadone on post-operative prognosis. RESULTS In our database, only 4.3% of patients were treated by methadone. However, this addiction is one of the most important stressors for psychiatrists and involves a great deal of multidisciplinary staff time. There are absolutely no guidelines on this topic. Due to the action of methadone, the pulmonary, cardiac, urologic, drug and immune side effects are more understandable. Thanks to clinical labels, we are able to handle this dual problem. Different parameters are considered such as patient's history, drug addiction, deterioration of physical condition, possible surgery and its consequences, choice of treatment to better estimate the post-operative prognosis. CONCLUSION Until now, there is nor indication or contra-indication regarding the duration of treatment by methadone for patients requiring pulmonary transplantation. The main advantage is the patient's stabilization by minimizing possible relapses. This advantage is to compare the following major inconvenience: increased confusional risk, delicate management of the post-operative pain, negative impact on the immunity. The support, a double psychoeducation and the patient's decision making are to be encouraged.