Journal article
Cannabis Dependence or Abuse in Kidney Transplantation: Implications for Posttransplant Outcomes
Transplantation, Vol.103(11), pp.2373-2382
11/01/2019
DOI: 10.1097/TP.0000000000002599
PMCID: PMC6679817
PMID: 30747847
Abstract
Background. Cannabis is categorized as an illicit drug in most US states, but legalization for medical indications is increasing. Policies and guidance on cannabis use in transplant patients remain controversial. Methods. We examined a database linking national kidney transplant records (n = 52 689) with Medicare claims to identify diagnoses of cannabis dependence or abuse (CDOA) and associations [adjusted hazard ratio (aHR) with 95% upper and lower confidence limits (CLs)] with graft, patient, and other clinical outcomes. Results. CDOA was diagnosed in only 0.5% (n = 254) and 0.3% (n = 163) of kidney transplant recipients in the years before and after transplant, respectively. Patients with pretransplant CDOA were more likely to be 19 to 30 years of age and of black race, and less likely to be obese, college-educated, and employed. After multivariate and propensity adjustment, CDOA in the year before transplant was not associated with death or graft failure in the year after transplant, but was associated with posttransplant psychosocial problems such as alcohol abuse, other drug abuse, noncompliance, schizophrenia, and depression. Furthermore, CDOA in the first year posttransplant was associated with an approximately 2-fold increased risk of death-censored graft failure (aHR, 2.29; 95% CL, 1.59-3.32), all-cause graft loss (aHR, 2.09; 95% CL, 1.50-2.91), and death (aHR, 1.79; 95% CL, 1.06-3.04) in the subsequent 2 years. Posttransplant CDOA was also associated with cardiovascular, pulmonary, and psychosocial problems, and with events such as accidents and fractures. Conclusions. Although associations likely, in part, reflect associated conditions or behaviors, clinical diagnosis of CDOA in the year after transplant appears to have prognostic implications for allograft and patient outcomes. Recipients with posttransplant CDOA warrant focused monitoring and support.
Details
- Title: Subtitle
- Cannabis Dependence or Abuse in Kidney Transplantation: Implications for Posttransplant Outcomes
- Creators
- Tarek Alhamad - Washington University in St. LouisFarrukh M. Koraishy - Saint Louis UniversityNgan N. Lam - University of AlbertaSreelatha Katari - Washington University in St. LouisAbhijit S. Naik - University of MichiganMark A. Schnitzler - Saint Louis UniversityHuiling Xiao - Saint Louis UniversityDavid A. Axelrod - Lahey Hospital and Medical CenterVikas R. Dharnidharka - Washington University in St. LouisHenry Randall - Saint Louis UniversityRosemary Ouseph - Saint Louis UniversityDorry L. Segev - Johns Hopkins UniversityDaniel C. Brennan - Johns Hopkins UniversityRadhika Devraj - Southern Illinois University EdwardsvilleBertram L. Kasiske - Hennepin County Medical CenterKrista L. Lentine - Saint Louis University
- Resource Type
- Journal article
- Publication Details
- Transplantation, Vol.103(11), pp.2373-2382
- DOI
- 10.1097/TP.0000000000002599
- PMID
- 30747847
- PMCID
- PMC6679817
- NLM abbreviation
- Transplantation
- ISSN
- 0041-1337
- eISSN
- 1534-6080
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 10
- Grant note
- R01DK096008; R01DK102981 / NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK) R01-DK096008 / National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK)
- Language
- English
- Date published
- 11/01/2019
- Academic Unit
- Surgery
- Record Identifier
- 9984322811402771
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