Marijuana use and post-transplant complications and non-compliance in liver transplant patients

Introduction

Liver transplant (LT) is a life-saving treatment for patients with liver disease. Nearly 5000 transplants are performed every year in the United States (U.S.).

Prior to receiving LT, candidates go through an extensive evaluation to identify any underlying comorbidities and psychosocial factors, including substance use, that may need to be addressed to make the intraoperative and postoperative course more successful. Marijuana continues to be the most common drug of use in the U.S. and has remained a controversial topic when it comes to solid organ transplant. ^, In medical practice, patients with marijuana use are considered to be at risk for post-transplant complications including noncompliance with immunosuppression, relapse or use of other illicit drugs, infections, particularly fungal infections, and behavioral and neuropsychiatric disorders. ^, A few studies have shown some benefits of marijuana use, particularly in cirrhotic patients, including improved hospitalization stay, mortality and symptom burden. ^, However, given the scarcity of allografts and the abundance of patients needing a new liver, careful selection of candidates becomes a necessity.

Thus, it is no surprise that many institutions in the US require patients to be abstinent from substances such as alcohol, tobacco, and illicit drugs, including marijuana, to qualify for a LT.

Only a few studies to date have looked at marijuana and post-LT complications and noncompliance.

^, With increasing legalization of marijuana across the U.S., it has become important to understand its implications when it comes to LT. We aimed to investigate pre-transplant marijuana use and its correlation with post-transplant outcomes including risk of infections, particularly fungemia, organ dysfunction, and other complications including rehospitalizations and death. We also aimed to assess non-compliance post-LT in patients with history of marijuana use.