J. Guorgui1, T. Ito1, A. Severance1, S. Younan1, M. Lu1, J. Lee1, J. DiNorcia1, V. G. Agopian1, D. G. Farmer1, R. W. Busuttil1, F. M. Kaldas1 1University Of California – Los Angeles,Department Of Surgery, The Dumont-UCLA Transplant Center,Los Angeles, CA, USA
Introduction: Marijuana is one of the most commonly used illicit drugs worldwide. In the United States, medicinal marijuana use is currently legal in thirty-four states and recreational use is legal in eleven states. Such widespread acceptance, both politically and socially, continues to challenge liver transplant (LT) programs to reevaluate their substance abuse policies pertaining to transplant candidates with active marijuana use. However, the impact of marijuana use on outcomes remains unclear. This study sought to examine the potential ramifications of pre and post-transplant marijuana use in LT recipients.
Methods: This is a single center retrospective review of 803 adult primary LT recipients between 1/2012 and 6/2018. Marijuana use was defined as either self-reported use or a positive urine toxicology screen. Patients were further classified as recent users (within 6 months pre-LT), former users (chronic use but no consumption within 6 months pre-LT), post-LT users, or non-users. Continuous and categorical variables were compared using the Mann-Whitney U test and Chi-square test, respectively. Survival curves were generated by the Kaplan–Meier method and differences in survival rates were analyzed using the Log rank test.
Results: Of 803 eligible patients, 170 (21%) were pre-LT marijuana users (40 recent; 130 former) and 45 were post-LT users. Pre-LT users were more likely to be male (77% vs 57%, p<0.001), Caucasian (52% % vs 35%, p<0.001), have a remote (70% vs 46%, p<0.001) and recent (13% vs 4%, p<0.001) history of tobacco use, and have a primary indication of HCV (50% vs 27%, p<0.001) compared to non-users. Pre-LT users also had a higher rate of post-LT marijuana use (23.3% (n=40) vs 0.8 % (n=5 ), p<0.001). There were no significant differences in post-LT outcomes; including acute rejection, respiratory complications, biliary complications, re-operation, post LT hospital stay, or readmission rates within 1 year for all pre and post-LT marijuana users compared to non-users (Figure). Additionally, there were no significant differences in short or long-term survival in pre or post-LT marijuana users (Figure).
Conclusions: This is the largest study assessing the impact of pre-LT marijuana use and the first to include post-LT users. Our results suggest that marijuana use pre or post-LT does not negatively impact patient or graft outcomes. Thus, this data might serve to reduce the current stigma surrounding medicinal marijuana use in LT patients, promote patient transparency, and guide policies that promote the proper medical management of these patients.
