Marijuana use should not preclude consideration for kidney transplantation

Abstract

Transplant eligibility for tobacco and/or marijuana using candidates varies among transplant centers. This study compared the impact of marijuana use and tobacco use on kidney transplant recipient outcomes. Kidney transplant recipients at a single center from 2001 to 2015 were reviewed for outcomes of all-cause graft loss, infection, biopsy-proven acute rejection, and estimated glomerular filtration rate between four groups: marijuana-only users, marijuana and tobacco users, tobacco-only users, and nonusers. The cohort (N = 919) included 48 (5.2%) marijuana users, 45 (4.8%) marijuana and tobacco users, 136 (14.7%) tobacco users, and 75% nonusers. Smoking status was not significantly associated with acute rejection, estimated glomerular filtration rate or pneumonia within one-year post-transplant in an adjusted model. Compared to nonuse, marijuana and tobacco use and tobacco-only use was significantly associated with increased risk of graft loss (aHR 1.68, P = .034 and 1.52, P = .006, respectively). Patients with isolated marijuana use had similar overall graft survival compared to nonusers (aHR 1.00, P = .994). Marijuana use should not be an absolute contraindication to kidney transplant. K E Y W O R D S alcoholism and substance abuse, graft survival, kidney (allograft) function/dysfunction

Epidemiology of cannabis use and associated outcomes among kidney transplant recipients: A meta‐analysis

“…Overall, the pooled estimated prevalence of cannabis use was 3.2% (95%CI 0.4%‐20.5%, I 2 = 97%). The use of cannabis was not significantly associated with all‐cause allograft failure (OR = 1.31, 95% CI 0.70‐2.46, I 2 = 71%) 28‐30 or mortality (OR = 1.52, 95% CI 0.59‐3.92, I 2 = 15%) 28,30 . The use of cannabis among kidney transplant recipients was significantly associated with increased death‐censored graft failure with pooled OR of 1.72 (95% CI 1.13‐2.60, I 2 = 43%) 28‐30 …”

“…Seven were not observational studies, and ten studies were excluded due to not providing the outcome of interest. Thus, four cohort studies 28‐31 with a total of 55 897 kidney transplant recipients were enrolled. Figure 1 outlines the flowchart of papers selected for inclusion.…”

“…Seven were not observational studies, and ten studies were excluded due to not providing the outcome of interest. Thus, four cohort studies [28][29][30][31] with a total of 55 897 kidney transplant recipients were enrolled. Full-text arƟcles excluded (n = 17) 10 arƟcles did not report the outcomes of interest; 7 arƟcles were not observaƟonal studies.…”

“…28,30 The use of cannabis among kidney transplant recipients was significantly associated with increased deathcensored graft failure with pooled OR of 1.72 (95% CI 1.13-2.60, I 2 = 43%). [28][29][30]…”

Public Appeals Challenging Criteria for Pediatric Organ Transplantation

“…32 But there is increasing evidence that overall graft survival is not adversely affected by recreational or medicinal marijuana use. 33,34 A restriction based on drug use smacks more of stigma against users than a sound, utility-based decision, overemphasizing the deleterious effects of marijuana in a way that we would not do with other deleterious behaviors (sedentary lifestyle, unhealthy food choices, recreational alcohol use, etc). 35 Riley's family was extremely grateful that Riley did receive a transplant, stating, "Penn did everything in their power.…”