Marijuana Use in Potential Liver Transplant Candidates

Abstract

Concern exists that liver transplant center substance abuse policies may have an inappropriate and disproportionate impact on marijuana users. Our hypothesis is that patients with chronic liver disease who were marijuana users will have inferior survival. This is a retrospective (1999-2007) cohort study. The primary outcome measure is time-dependent, adjusted patient survival from the time of liver transplant evaluation. The primary exposure variable is a positive cannabinoid toxicology screen during the liver transplant evaluation period. Overall, 155 patients qualified as marijuana users while 1334 patients were marijuana non-users. Marijuana users were significantly (p < 0.05) younger (48.3 vs. 52.1), more likely to be male (78.1% vs. 63.0%), have hepatitis C (63.9% vs. 40.6%) and were less likely to receive a transplant (21.8% vs. 14.8%). Marijuana users were more likely to use tobacco, narcotics, benzodiazepines, amphetamines, cocaine or barbiturates (p < 0.05). Unadjusted survival rates were similar between cohorts. Upon multivariate analysis, MELD score, hepatitis C and transplantation were significantly associated with survival, while marijuana use was not (HR 1.09, 95% CI 0.78-1.54). We conclude that patients who did and did not use marijuana had similar survival rates. Current substance abuse policies do not seen to systematically expose marijuana users to additional risk of mortality.

National survey of provider opinions on controversial characteristics of liver transplant candidates

“…A 20‐item questionnaire was developed after a comprehensive literature review identified the most controversial medical and psychosocial characteristics relevant to liver transplant listing decisions . The survey took approximately 10 minutes to complete and queried providers about their personal opinions concerning the following patient characteristics: (1) advanced age, (2) HIV seropositivity, (3) obesity, (4) psychiatric diagnoses, (5) current incarceration, (6) marijuana use, (7) cognitive disability or mental retardation, and (8) citizenship/residency status.…”

Individual and environmental correlates and predictors of early adherence and outcomes after liver transplantation

“…Findings about the impact of specific behaviors (eg, medication adherence) on specific health outcomes in this population are mixed 8,9. Although relapse to drug and/or alcohol use does not appear to directly affect short-term outcome, rates are significant and little is known about the longer-term effects of recidivism to alcohol or other drugs of abuse on adherence to the rest of the treatment regimen or on health outcomes 10,11. Some research on patients with alcoholic liver disease suggests that nonadherence with other aspects of the treatment regimen, particularly relapse to smoking, is concomitant with relapse to drinking and affects morbidity and mortality 12,13…”

Do cannabinoids have a therapeutic role in transplantation?

“…Marijuana has over 480 compounds [61] and the effect of this complex mixture on inflammation and allograft rejection remains unclear. In a recent study, it was noted that patients that were positive for marijuana had similar survival rates when compared to patients that did not test positive [62], thereby suggesting that marijuana was not beneficial for liver transplant acceptance. It should be noted that some liver transplant centers have maintained a policy of marijuana abstinence for any patient to be considered for liver transplantation [63], which has created significant controversy following the death of a patient who was declined a liver transplant for using medical marijuana [62, 64].…”