使用大麻患者的肝移植候选资格及预后评估：是时候改变政策了吗？
Review of liver transplantation candidacy and outcomes among patients who use cannabis: Is it time for a change in policy?
作者信息
Yau Man Ting Kristina, Hussaini Trana, Yoshida Eric M
机构信息
Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
出版信息
Can Liver J. 2023 Jul 26;6(2):269-277. doi: 10.3138/canlivj-2022-0038. eCollection 2023 Jul.
BACKGROUND
Recreational cannabis was legalized in Canada in 2018. A controversial contraindication for liver transplantation is cannabis. There is currently no consensus regarding cannabis use in liver transplant candidates. We aim to investigate liver transplantation candidacy and outcomes among cannabis users.
METHODS
English peer-reviewed studies on PubMed and Google Scholar were searched on September 9, 2022, using keywords including "cannabis," "liver transplantation," and their synonyms. Titles and abstracts were screened, followed by full texts. Reference lists were reviewed. Studies that investigated liver transplantation candidacy and outcomes among cannabis users were included.
RESULTS
The proportion of patients listed for liver transplantation was significantly less among cannabis users than among non-users. Time to listing was longer for cannabis users than non-users. The incidence of delisting was similar. There is an inconsistency between transplant centres regarding transplantation candidacy for cannabis users. While only 14% of Canadian centres had a policy in place and preferred candidates to abstain or decrease cannabis use before transplantation, a third of Canadian centres rejected cannabis users. Observational studies failed to demonstrate significant differences in patient survival between pre-transplantation cannabis users and non-users. However, self-reported mental health ratings were worse in post-transplantation cannabis users than in non-users and former users.
CONCLUSIONS
Current observational data do not support a link between cannabis use and poor patient survival post-transplantation. However, high-quality prospective studies are needed to better elucidate the impact of cannabis use on liver transplantation outcomes. Liver transplant candidacy should be evaluated through a multidisciplinary and comprehensive approach considering all relevant psychosocial factors.
背景
2018年加拿大将娱乐用大麻合法化。大麻是肝移植中一个有争议的禁忌证。目前对于肝移植候选者使用大麻尚无共识。我们旨在调查大麻使用者中的肝移植候选资格及结局。
方法
2022年9月9日在PubMed和谷歌学术上检索英文同行评审研究，使用的关键词包括“大麻”“肝移植”及其同义词。先筛选标题和摘要，然后是全文。对参考文献列表进行审查。纳入调查大麻使用者肝移植候选资格及结局的研究。
结果
大麻使用者中列入肝移植名单的患者比例显著低于非使用者。大麻使用者列入名单的时间比非使用者更长。退出名单的发生率相似。各移植中心对于大麻使用者的移植候选资格存在不一致。虽然只有14%的加拿大中心制定了政策，希望候选者在移植前戒除或减少大麻使用，但三分之一的加拿大中心拒绝大麻使用者。观察性研究未能证明移植前大麻使用者和非使用者之间在患者生存率上有显著差异。然而，自我报告的心理健康评分在移植后大麻使用者中比在非使用者和既往使用者中更差。
结论
目前的观察性数据不支持大麻使用与移植后患者生存不良之间存在关联。然而，需要高质量的前瞻性研究来更好地阐明大麻使用对肝移植结局的影响。应通过考虑所有相关心理社会因素的多学科综合方法来评估肝移植候选资格。
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