Cannabis abuse and dependence in kidney transplant candidates

Abstract

Objective: Cannabis is the most commonly used non-alcohol intoxicant in the general population. There are no consistent guidelines on the implications of cannabis abuse and dependence (CAD) in kidney transplant candidates. The aims of this study were to characterize kidney transplant candidates with comorbid CAD and examine the implications of CAD on transplant candidacy. Method: This was a retrospective cohort study of kidney transplant candidates meeting diagnostic criteria for CAD at a tertiary center from 2012-2016. Candidates were reviewed for psychiatric and substance use disorders (SUDs), family history, and medical variables. The cohort was divided by severity of CAD and transplant listing status for comparisons. Statistical analysis included Kruskal-Wallis tests for continuous variables and Fisher's Exact Test for categorical variables. Results: Sixty-one of 2067 (3%) kidney transplant candidates met criteria for CAD, and 13/61 (21%) underwent transplantation. Of 61, 58% smoked cannabis daily, 47% had alcohol dependence history, 31% had other illicit drug dependencies, 38% were smokers, 60% had a SUD family history, and 42% and 27% had depressive and anxiety disorders, respectively. Severity of CAD was inversely associated with transplant listing; those with cannabis abuse were more often listed than those with dependence (67% vs 33%, p=0.02) by study end. Three case presentations illustrate cannabis-related issues.

Effects in rats of adolescent exposure to Cannabis sativa on emotional behavior and adipose tissue

“…In kidney transplant candidates, cannabis abuse was associated with psychiatric comorbidities (24). Cannabis can cause behavioral changes, and movement disturbances, while higher doses inhibit movement and lower doses stimulate it (24). In our study, similarly, behavioral assessment revealed an increasing trend for anxiety level after 2 and 3 weeks following cannabis use.…”

“…The fi rst report of cannabis allergy dates back to 1971 signifi cantly affected the quality of life (23). In kidney transplant candidates, cannabis abuse was associated with psychiatric comorbidities (24). Cannabis can cause behavioral changes, and movement disturbances, while higher doses inhibit movement and lower doses stimulate it (24).…”

A Review of the Prevalence of Illicit Substance Use in Solid-Organ Transplant Candidates and the Effects of Illicit Substance Use on Solid-Organ Transplant Treatment Outcomes

“…Thirteen studies reported the rates of illicit substance use in solid-organ transplant candidates ( Table 1). Seven studies reviewed retrospective data [13][14][15][16][17][18]22], three studies used crosssectional assessment [10,[25][26], one study analyzed the national transplant registry [23], one study utilized prospective study design [19], and one study used a survey [24] to collect data. The sample sizes of these studies ranged from 59 [16] to 52,689 [23].…”

“…Eight studies were on liver transplant, three on kidney transplant, and two on cardiac transplantation. Three studies primarily focused on cannabis use [13,23], one on injection drug use (IDU) [16], three studies did not present data on individual substances [18,[24][25], and the others presented data on multiple substances. In the overall cohort, any illicit drug was used by 35% at some point in time, most frequently cannabis (31%), amphetamine (16%), heroin (5%), cocaine, inhalants, and hallucinogens (8% each)…”

“…In a study by Stark et al (2019), 3% of those referred by social workers to the addiction psychiatrist met the criteria for cannabis abuse or dependence (CAD) [13]. Amongst the cannabis users, 58% consumed cannabis daily, 47% had a history of alcohol dependence, and 31% also had other substance use history [13]. The low rate of marijuana and other substance use could be due to the fact that abstinence was actively encouraged for listing.…”