History of marijuana use does not affect outcomes on the liver transplant waitlist

AbstractBackgroundData 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.MethodsRetrospective cohort of adults evaluated for LT over 2 years at a large LT center. Marijuana use defined by self-report in psychosocial assessment and/or positive urine toxicology. Ongoing marijuana use was not permitted for LT listing during study period.Results884 adults were evaluated and 585 (66%) were listed for LT (median follow up 1.4 years, IQR 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 (IRR=1.9) and hepatitis C (IRR=2.1) vs. 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 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).ConclusionsUnlike 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. 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 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 884 adults were evaluated and 585 (66%) were listed for LT (median follow up 1.4 years, IQR 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 (IRR=1.9) and hepatitis C (IRR=2.1) vs. 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 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. Corresponding Author: Prashant Kotwani, MD, Email – prashant.kotwani@ucsf.edu; prashant.kotwani@gmail.com, 505 Parnassus Avenue, Room 987, San Francisco, CA 94143, Phone: 415-476-1528, Fax: 415-502-1976 Authorship PK - contributed to research design, data collection, data analysis, manuscript preparation VS – contributed to research design, data analysis, manuscript preparation JLD – contributed to data analysis, manuscript preparation JR – contributed to research design, manuscript preparation FY – contributed to research design, manuscript preparation BH – contributed to research design, data analysis, manuscript preparation Conflict of Interest The authors declare no conflicts of interest Funding This work was supported, in part, by the Biostatistics Core of the UCSF Liver Center (P30 DK026743). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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