Cannabis Dependence or Abuse in Kidney Transplantation: Implications for Posttransplant Outcomes

Background: Cannabis is categorized as an illicit drug in most US states, but legalization for medical indications is increasing. Policies and guidance regarding 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, 95% LCL aHR95% UCL) 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 aged 19-30 and 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. Further, CDOA in the first year posttransplant was associated with an approximately 2-fold increased risk of death-censored graft failure (aHR 1.592.293.32), all-cause graft loss (aHR 1.502.092.91), and death (aHR 1.061.793.04) 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: While 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. DISCLOSURES: The authors declare no conflicts of interest. FUNDING: This work was conducted under the auspices of the Minneapolis Medical Research Foundation (MMRF), contractor for the Scientific Registry of Transplant Recipients (SRTR), as a deliverable under contract no. HHSH250201000018C (U.S. Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation). As a U.S. Government-sponsored work, there are no restrictions on its use. The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the U.S. Government. This work was supported by a grant from the National Institutes of Health (NIH)/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) R01-DK096008. NNL was supported by a KRESCENT New Investigator Award. Corresponding Author: Krista L. Lentine, MD, PhD, Address: Saint Louis University Transplant Center, 1402 S. Grand Blvd., St. Louis, MO 63104, Phone: (314) 577-8765, Email: krista.lentine@health.slu.edu Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2WWuPZb