Coffman Kathy L
Department of Psychiatry and Psychology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Curr Opin Organ Transplant. 2008 Apr;13(2):189-95. doi: 10.1097/MOT.0b013e3282f56139.
Cannabis is currently the most widely used illicit substance in the world. The issue of how to handle transplant candidates with active use of cannabis is a commonly encountered one for transplant-selection committees.
Correlates of marijuana use include increased risk of use of other illicit substances, increased risk of affective disorders and psychosis, as well as impaired cognition and motor skills. Risk of fungal infections and possible effects on cellular immunity that may increase cancer risk have also been reported. Reliability of laboratory testing for cannabis is discussed. False-negatives may occur with stealth peroxidases and false-positives with efavirenz (Sustiva). Photometric immunoassay (EMITS) has a 3% false-positive rate. Using a cutoff point of 20 ng/ml with confirmation via GC/MS will give a 'virtually 100% reliable accuracy' in detecting cannabis abuse.
Guidelines on management of the problem should be based on objective medical evidence on the health effects of marijuana, as well as on the implications in the transplant setting where medical urgency can drive medical decision-making. A recent survey of 16 academic transplant centers showed little consensus on guidelines for length of abstinence prior to listing candidates for transplantation.
大麻是目前世界上使用最广泛的非法物质。对于移植选拔委员会来说，如何处理正在使用大麻的移植候选人这一问题很常见。
使用大麻的相关因素包括使用其他非法物质的风险增加、情感障碍和精神病风险增加，以及认知和运动技能受损。也有报道称存在真菌感染风险以及对细胞免疫可能产生的影响，这可能会增加癌症风险。讨论了大麻实验室检测的可靠性。隐形过氧化物酶可能出现假阴性，依非韦伦（施多宁）可能出现假阳性。光度免疫测定法（EMIT）有3%的假阳性率。使用20纳克/毫升的临界值并通过气相色谱/质谱法进行确认，在检测大麻滥用方面将具有“几乎100%可靠的准确性”。
关于该问题的管理指南应基于关于大麻对健康影响的客观医学证据，以及在移植环境中医疗紧迫性可能推动医疗决策的影响。最近对16个学术移植中心的调查显示，在列出移植候选人之前的禁欲时间指南方面几乎没有共识。
