Marijuana use among adult liver transplant candidates and recipients

Abstract

Marijuana (MJ) is the most commonly used illicit drug in the UnitedStates with an estimated 10% of US adults reporting active MJ use in the past month. 1 The prevalence of MJ use in the US has significantly increased over the past 15 years. 1 Touted clinical uses of MJ include the treatment of pain, muscle spasticity, refractory epilepsy, and nausea. 2 However, MJ use has also been associated with various adverse effects including infection, cardiopulmonary disease, neuropsychiatric, and behavioral problems. 3 More than 50% of LT candidates have substance use disorder (SUD) including alcohol-related liver disease (ALD) and injection drug use associated with viral hepatitis. 4 MJ use among solid organ transplant patients is an area of little policy uniformity. Many studies have demonstrated adverse effects of tobacco use in LT candidates and recipients resulting in many US programs prohibiting tobacco use in their LT candidates. [5][6][7] Only a few studies have investigated the potential harm of MJ use in LT candidates and recipients and risks remain largely unknown. As such, national MJ-related policies and procedures for the evaluation and listing of transplant patients remain highly variable. 8,9

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

“…The proportion of pre-transplantation marijuana users listed for liver transplantation was significantly less than that of non-users as shown in two studies (21,22). The odd of marijuana users being listed for liver transplantation was 0.67 (95% CI = 0.50-0.91, p = 0.010) (21). Interestingly, although the proportion of pre-transplantation marijuana users increased with time, the proportion of pre-transplantation marijuana users being listed for liver transplantation did not change (21).…”

“…Three retrospective studies compared the rates of liver transplantation listing, duration of the listing, and rates of liver transplantation between marijuana users and non-users. The proportion of pre-transplantation marijuana users listed for liver transplantation was significantly less than that of non-users as shown in two studies (21,22). The odd of marijuana users being listed for liver transplantation was 0.67 (95% CI = 0.50-0.91, p = 0.010) (21).…”

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

“…Cannabis has not been significantly associated with liver transplantation recipient survival, rates of complications, and hospital readmissions or length of stay [23,[25][26][27][28]. Cannabis users, however, have elevated scores on the Stanford Integrated Psychosocial Assessment for Transplant scale and higher rates of alcohol and polysubstance use, past SUD treatment, and use of psychiatric medications which may correlate with longer time-to-listing [23].…”

“…Cannabis has not been significantly associated with liver transplantation recipient survival, rates of complications, and hospital readmissions or length of stay [23,25–28]. Cannabis users, however, have elevated scores on the Stanford Integrated Psychosocial Assessment for Transplant scale and higher rates of alcohol and polysubstance use, past SUD treatment, and use of psychiatric medications which may correlate with longer time-to-listing [23]. Similar psychosocial complexity and risk are also documented in the kidney population [29–32] where approximately 3% of patients have cannabis use disorder (CUD) [33] a condition defined by the Diagnostic and Statistical Manual of Mental Disorders 5 criteria [34].…”

“…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.…”