Panchani Nishah, Aryan Mahmoud, Dabke Isha, Ousley Robert, Reif Meagan, Hegazy Yassmin, Wilcox Charles, Shoreibah Mohamed
Tinsley Harrison Internal Medicine Residency Program, University of Alabama at Birmingham, Birmingham, AL, United States.
Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL, United States.
Am J Med Sci. 2023 Feb;365(2):115-120. doi: 10.1016/j.amjms.2022.09.022. Epub 2022 Oct 4.
Liver transplant (LT) is a lifesaving treatment for patients with end stage liver disease. Historically, institutions across the United States have deemed active marijuana use as an exclusion criterion for listing. This study aims to investigate LT outcomes in patients with history of marijuana use prior to LT.
We performed a retrospective review of 111 patients who tested positive for marijuana on urine drug screen during initial LT evaluation between February 2016 and January 2021. 100 non-marijuana users who underwent LT were cross matched for control. Patient demographics, substance use history, and transplant decisions were recorded. Post-LT variables were also collected up to 1 year post surgery including postoperative infections, issues with non-compliance, and continued substance use. Chi-square analysis was used to assess the association between pre-transplant marijuana use and post-transplant complications. Logistics regression was implemented to measure associations amongst the entire cohort.
From 111 marijuana users, 32 (29%) received a transplant. There was no statistical difference in post-LT outcomes between marijuana and non-marijuana users, including incidence of cardiac, respiratory, renal, psychiatric, or neurological complications, as well as readmission rates post-surgery. There were no statistically significant associations between marijuana use with post-transplant bacterial or fungal infections, medication non-compliance, or continued substance use (all p>0.05). Marijuana use was associated with pre-LT tobacco use (p = 0.020).
Our data indicates that marijuana is not associated with increased risk of postoperative noncompliance, other organ complications, infections, or death. As a single factor, marijuana may not need to be a contraindication for LT.
肝移植（LT）是终末期肝病患者的一种挽救生命的治疗方法。从历史上看，美国各地的机构都将积极使用大麻视为列入移植名单的排除标准。本研究旨在调查肝移植前有大麻使用史患者的肝移植结局。
我们对2016年2月至2021年1月初次肝移植评估期间尿液药物筛查大麻呈阳性的111例患者进行了回顾性研究。100例接受肝移植的非大麻使用者作为对照进行交叉匹配。记录患者的人口统计学、物质使用史和移植决定。还收集了术后1年内的肝移植后变量，包括术后感染、不依从问题和持续物质使用情况。采用卡方分析评估移植前大麻使用与移植后并发症之间的关联。实施逻辑回归以测量整个队列之间的关联。
在111名大麻使用者中，32名（29%）接受了移植。大麻使用者和非大麻使用者的肝移植后结局没有统计学差异，包括心脏、呼吸、肾脏、精神或神经并发症的发生率以及术后再入院率。大麻使用与移植后细菌或真菌感染、药物不依从或持续物质使用之间没有统计学上的显著关联（所有p>0.05）。大麻使用与移植前吸烟有关（p = 0.020）。
我们的数据表明，大麻与术后不依从、其他器官并发症、感染或死亡风险增加无关。作为单一因素，大麻可能无需成为肝移植的禁忌证。
