Runge Ava, Loeb Becca, Shui Amy M, Fenton Cynthia, Lai Jennifer, Rubin Jessica
Department of Medicine, University of California San Francisco, San Francisco, California, USA.
Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA.
Liver Transpl. 2025 Feb 21. doi: 10.1097/LVT.0000000000000585.
Cannabis use is increasing in the United States, including among candidates for liver transplants (LTs). Although the anesthesia literature suggests an association between cannabis use and increased postoperative pain, the impact of cannabis use on post-LT opioid use remains unknown. This study investigates changes in cannabis use at a transplant center over time, as well as the impact of cannabis use on post-LT opioid use, health care utilization, and mortality. We included 4236 patients evaluated for LT at our institution between January 2013 and July 2023. Our primary risk factor was cannabis use, defined as urine toxicology positive for cannabis within 90 days of LT evaluation. Our primary outcome was post-LT opioid use, including oral morphine equivalents received during the LT hospitalization and discharge opioid prescriptions. We used multivariable logistic and quantile regression to compare post-LT opioid use, health care utilization outcomes, and mortality between cannabis users and nonusers. Cannabis use was associated with higher oral morphine equivalent use in the 48 hours after LT ( p =0.04). There were no statistically significant differences between groups in 72-hour ( p =0.07) or 7-day cumulative oral morphine equivalent ( p =0.33), opioid prescriptions on discharge ( p =0.25), hospital length of stay ( p =0.69), intensive care unit length of stay ( p =0.94), 90-day readmission ( p =0.66), or 90-day mortality ( p =0.96). While cannabis use before LT was associated with significantly higher opioid use in the immediate postoperative period, this did not translate to differences in opioid use beyond 48 hours after LT, or short-term health care utilization or clinical outcomes. These findings should help set provider expectations for immediate post-LT pain control. Our findings support the growing body of literature that fails to identify an association between pre-LT cannabis use and post-LT outcomes.
在美国，大麻的使用呈上升趋势，包括在肝移植（LT）候选人中。尽管麻醉学文献表明大麻使用与术后疼痛加剧之间存在关联，但大麻使用对肝移植后阿片类药物使用的影响仍不清楚。本研究调查了某移植中心大麻使用情况随时间的变化，以及大麻使用对肝移植后阿片类药物使用、医疗保健利用和死亡率的影响。我们纳入了2013年1月至2023年7月期间在我们机构接受肝移植评估的4236例患者。我们的主要风险因素是大麻使用，定义为在肝移植评估后90天内尿液毒理学检测大麻呈阳性。我们的主要结局是肝移植后阿片类药物的使用，包括肝移植住院期间接受的口服吗啡当量和出院时的阿片类药物处方。我们使用多变量逻辑回归和分位数回归来比较大麻使用者和非使用者之间肝移植后阿片类药物的使用、医疗保健利用结局和死亡率。大麻使用与肝移植后48小时内较高的口服吗啡当量使用相关（p = 0.04）。两组在72小时（p = 0.07）或7天累积口服吗啡当量（p = 0.33）、出院时的阿片类药物处方（p = 0.25）、住院时间（p = 0.69）、重症监护病房住院时间（p = 0.94）、90天再入院率（p = 0.66）或90天死亡率（p = 0.96）方面没有统计学上的显著差异。虽然肝移植前使用大麻与术后即刻阿片类药物使用显著增加相关，但这并未转化为肝移植后48小时后阿片类药物使用、短期医疗保健利用或临床结局的差异。这些发现应有助于为肝移植后即刻疼痛控制设定医疗人员的预期。我们的发现支持了越来越多的文献，这些文献未能确定肝移植前使用大麻与肝移植后结局之间的关联。
