University of Michigan Department of Psychiatry, 9D 9816 University Hospital, 1500 E. Medical Center Dr. SPC 5118, Ann Arbor, MI, 48109-5118, USA.
Curr Psychiatry Rep. 2017 Oct 27;19(11):91. doi: 10.1007/s11920-017-0843-1.
Physicians of all disciplines must rapidly adjust their clinical practices following the expansion of marijuana legalization across the country. Organ transplantation teams are uniquely struggling in this gray zone with eight states having passed laws explicitly banning the denial of transplant listing based on a patient's use of medical marijuana. In this review, we examine the clinical evidence of marijuana use in transplant patients to enable psychiatric providers to meaningfully contribute to the relevant medical and psychiatric aspects of this issue in a unique patient population.
There is no consensus among experts regarding marijuana use in transplantation patients. There are extant case reports of post-transplant complications attributed to marijuana use including membranous glomerulonephritis, ventricular tachycardia, and tacrolimus toxicity. However, recent studies suggest that the overall survival rates in kidney, liver, lung, and heart transplant patients using marijuana are equivalent to non-users. Transplant teams should not de facto exclude marijuana users from transplant listing but instead holistically evaluate a patient's candidacy, integrating meaningful medical, psychiatric, and social variables into the complex decision-making process. Psychiatric providers can play a key role in this process. Appropriate stewardship over donor organs, a limited and precious resource, will require a balance of high-clinical standards with inclusive efforts to treat as many patients as possible.
随着全美范围内大麻合法化的扩张，所有医学领域的医生都必须迅速调整他们的临床实践。器官移植团队在这个灰色地带面临着独特的挑战，有八个州已经通过法律明确禁止基于患者使用医用大麻而拒绝将其列入移植名单。在本次综述中，我们研究了大麻在移植患者中的使用的临床证据，以使精神科医生能够在这个独特的患者群体中对这个问题的相关医学和精神方面做出有意义的贡献。
专家之间对于移植患者使用大麻的问题没有共识。有一些关于移植后并发症归因于大麻使用的病例报告，包括膜性肾小球肾炎、室性心动过速和他克莫司毒性。然而，最近的研究表明，使用大麻的肾、肝、肺和心脏移植患者的总体生存率与非使用者相当。移植团队不应该事实上将大麻使用者排除在移植名单之外，而应该全面评估患者的候选资格，将有意义的医疗、精神和社会变量纳入复杂的决策过程。精神科医生可以在这个过程中发挥关键作用。对供体器官的适当管理，这是一种有限而宝贵的资源，需要在高标准的临床治疗与尽可能多的治疗患者的包容性努力之间取得平衡。
