Fabbri Kassandra R, Anderson-Haag Tracy L, Spenningsby Anne M, Israni Ajay, Nygaard Rachel M, Stahler Paul A
Department of Pharmacy, Hennepin Healthcare, Minneapolis, MN, USA.
Department of Nephrology, Hennepin Healthcare, Minneapolis, MN, USA.
Clin Transplant. 2019 Oct;33(10):e13706. doi: 10.1111/ctr.13706. Epub 2019 Oct 16.
Transplant eligibility for tobacco and/or marijuana using candidates varies among transplant centers. This study compared the impact of marijuana use and tobacco use on kidney transplant recipient outcomes. Kidney transplant recipients at a single center from 2001 to 2015 were reviewed for outcomes of all-cause graft loss, infection, biopsy-proven acute rejection, and estimated glomerular filtration rate between four groups: marijuana-only users, marijuana and tobacco users, tobacco-only users, and nonusers. The cohort (N = 919) included 48 (5.2%) marijuana users, 45 (4.8%) marijuana and tobacco users, 136 (14.7%) tobacco users, and 75% nonusers. Smoking status was not significantly associated with acute rejection, estimated glomerular filtration rate or pneumonia within one-year post-transplant in an adjusted model. Compared to nonuse, marijuana and tobacco use and tobacco-only use was significantly associated with increased risk of graft loss (aHR 1.68, P = .034 and 1.52, P = .006, respectively). Patients with isolated marijuana use had similar overall graft survival compared to nonusers (aHR 1.00, P = .994). Marijuana use should not be an absolute contraindication to kidney transplant.
对于使用烟草和/或大麻的候选者，不同移植中心的移植资格标准各异。本研究比较了使用大麻和使用烟草对肾移植受者预后的影响。对2001年至2015年在单一中心接受肾移植的受者进行回顾，分析四组人群的全因移植肾丢失、感染、活检证实的急性排斥反应以及估计肾小球滤过率的预后情况，这四组分别为：仅使用大麻者、同时使用大麻和烟草者、仅使用烟草者以及不使用者。该队列（N = 919）包括48名（5.2%）大麻使用者、45名（4.8%）大麻和烟草使用者、136名（14.7%）烟草使用者以及75%的不使用者。在调整模型中，吸烟状况与移植后一年内的急性排斥反应、估计肾小球滤过率或肺炎无显著相关性。与不使用相比，同时使用大麻和烟草以及仅使用烟草与移植肾丢失风险增加显著相关（调整后风险比分别为1.68，P = 0.034和1.52，P = 0.006）。仅使用大麻的患者与不使用者的总体移植肾存活率相似（调整后风险比为1.00，P = 0.994）。使用大麻不应成为肾移植的绝对禁忌证。
