Cannabinoid Use Among Liver Transplant Recipients

Abstract

The effect of cannabinoids on liver transplant outcomes is an area of active research. We aimed to investigate marijuana (MJ) and cannabidiol (CBD) use among liver transplant recipients at the University of Colorado Hospital (UCH), specifically prevalence, habits, and predictors of use. Liver transplant recipients followed at UCH with valid email addresses were sent an informed consent postcard and survey invitation. This exploratory survey was conducted using REDCap. IBM SPSS Statistics software was used for statistical analysis. Of 1227 recipients who were sent surveys, 538 people responded. On average, respondents were 59 years old, with 63.7% male and 81.7% White. Hepatitis C virus (HCV; 30.4%) and alcohol use (17.7%) were the most common etiologies of liver disease. Among respondents, 23.8% reported current MJ use. Methods of use included smoking (72.4%), ingestion (55.3%), and vaporization (31.7%). Top reasons for MJ use were recreation (56.5%), anxiety (54.8%), and pain (53.2%). Among respondents, 21.0% currently used CBD, usually in the form of creams or lotions (58.9%) and to relieve pain (84.9%) and anxiety (31.1%). In multivariable analysis, age (odds ratio [OR], 0.941; 95% confidence interval [CI], 0.923-0.959; P < 0.001), diabetes mellitus (OR, 0.357; 95% CI, 0.171-0.746; P = 0.01), HCV cirrhosis (OR, 3.949; 95% CI, 2.281-6.835; P < 0.001), alcohol-related cirrhosis (OR, 2.101; 95% CI, 1.202-3.671; P = 0.01), and current tobacco use (OR, 2.918; 95% CI, 1.065-7.990; P = 0.04) were significant predictors of MJ use. Our study shows that cannabinoid use after liver transplant is common. MJ use is associated with decreasing age, alcohol-related and HCV cirrhosis, and tobacco use. Anxiety, pain, and recreation were top reasons for its use. Transplant teams should address reasons why their patients use MJ and CBD and develop programs to mitigate anxiety and pain after transplant. Further studies are needed to examine effects of cannabinoids on liver transplant outcomes.

Review of liver transplantation candidacy and outcomes among patients who use cannabis: Is it time for a change in policy?

“…A survey study showed that self-reported physical health ratings were not significantly different among post-transplantation marijuana users, former marijuana users, and non-users (3). Self-reported mental health ratings were worse among post-transplantation marijuana users as compared to former users and non-users, although it is not known if this was directly due to marijuana use or if self-perceived worse mental health resulted in marijuana use (3). We note, however, that the designs of the above studies are subject to selection and reporting biases (3,28).…”

“…Self-reported mental health ratings were worse among post-transplantation marijuana users as compared to former users and non-users, although it is not known if this was directly due to marijuana use or if self-perceived worse mental health resulted in marijuana use (3). We note, however, that the designs of the above studies are subject to selection and reporting biases (3,28). Also, important factors like the route of marijuana administration, the quantity of marijuana use, and toxicology screens were not determined and included in the analysis (28).…”

“…In 2021, 17% of the Canadian population used cannabis, with the majority using it once a day (1). Cannabis is also reported to be commonly used by liver transplant candidates for numerous reasons including anxiety, pain, nausea, insomnia, and recreation (3).…”

Substance use disorders in organ transplantation: perennial challenges and interprofessional opportunities

“…Cannabinoids are among the most controversial topics that SOT clinicians encounter [22] as their use continues to rapidly gain widespread legal and societal acceptance. Use is similarly increasing among liver transplantation patients with 12-month cannabis use rates in candidates at 11.0% and recipient rates of active cannabis use of 23.8% and rates of active cannabidiol use of 21.0% [23,24 ▪ ]. Cannabinoid data in SOT exist primarily in liver and kidney populations and less is known about their effects in heart and lung candidates and recipients.…”

CAQ Corner: Psychosocial and ethical considerations in patient selection for liver transplantation

“…[1,2] Cannabinoids Social, legal, and medical landscapes of cannabinoid use are rapidly evolving in the United States, and LT policies are similarly heterogenous. [8] Cannabinoid use is increasing in LT patients, [18,19] and there is no expert consensus regarding cannabinoid use in LT despite the numerous medical and psychosocial considerations of which clinicians must be aware including possible drug interactions with immunosuppressants. [20] A minority of LT programs allow active marijuana use in their candidates.…”