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History of Marijuana Use Does Not Affect Outcomes on the Liver Transplant Waitlist

Kotwani, Prashant, MD1; Saxena, Varun, MD1; Dodge, Jennifer, L., MPH2; Roberts, John, MD2; Yao, Francis, MD1; Hameed, Bilal, MD1

doi: 10.1097/TP.0000000000002045
Original Clinical Science—Liver
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Background Data are limited on marijuana use and its impact on liver transplant (LT) waitlist outcomes. We aimed to assess the risk of waitlist mortality/delisting and likelihood of LT among prior marijuana users and to determine the prevalence and factors associated with marijuana use.

Methods Retrospective cohort of adults evaluated for LT over 2 years at a large LT center. Marijuana use was defined by self-report in psychosocial assessment and/or positive urine toxicology. Ongoing marijuana use was not permitted for LT listing during study period.

Results Eight hundred eighty-four adults were evaluated, and 585 (66%) were listed for LT (median follow-up, 1.4 years; interquartile range, 0.5-2.0). Prevalence of marijuana use was 48%, with 7% being recent users and 41% prior users. Marijuana use had statistically significant association with alcoholic cirrhosis (incidence rate ratio [IRR], 1.9) and hepatitis C (IRR, 2.1) versus hepatitis B, tobacco use (prior IRR, 1.4; recent IRR, 1.3 vs never), alcohol use (never IRR 0.1; heavy use/abuse IRR 1.2 vs social), and illicit drug use (prior IRR, 2.3; recent, 1.9 vs never). In adjusted competing risk regression, marijuana use was not associated with the probability of LT (prior hazard ratio [HR], 0.9; recent HR, 0.9 vs never) or waitlist mortality/delisting (prior HR, 1.0; recent HR, 1.0 vs never). However, recent illicit drug use was associated with higher risk of death or delisting (HR, 1.8; P = 0.004 vs never).

Conclusions Unlike illicit drug use, marijuana use was not associated with worse outcomes on the LT waitlist. Prospective studies are needed to assess ongoing marijuana use on the LT waitlist and post-LT outcomes.

In this single-center study, the authors showed that historical marijuana use is not associated with adverse effects on liver transplant waitlist outcomes, including waitlist mortality/delisting and likelihood of liver transplantation.

1 Division of Gastroenterology, Department of Medicine, University of California, San Francisco, CA.

2 Department of Surgery, University of California San Francisco, San Francisco, CA.

Received 29 June 2017. Revision received 6 November 2017.

Accepted 9 November 2017.

This work was supported, in part, by the Biostatistics Core of the UCSF Liver Center (P30 DK026743).

The authors declare no conflicts of interest.

P.K. contributed to research design, data collection, data analysis, and article preparation. V.S. contributed to research design, data analysis, and article preparation. J.L.D. contributed to data analysis and article preparation. J.R. contributed to research design and article preparation. F.Y. contributed to research design and article preparation. B.H. contributed to research design, data analysis, and article preparation.

Correspondence: Prashant Kotwani, MD, 505 Parnassus Ave, Rm 987, San Francisco, CA 94143. (prashant.kotwani@ucsf.edu); (prashant.kotwani@gmail.com).

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