Kidney Week

Abstract: TH-PO987

Cannabis Dependence or Abuse before and after Kidney Transplantation: Implications for Post-Transplant Outcomes

Session Information

• Transplant Recipient Education, Adherence, and Novel Risk Factors for Graft Loss
  November 02, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Transplantation

• 1702 Transplantation: Clinical and Translational

Authors

• Lentine, Krista L., Saint Louis University , St. Louis, Missouri, United States

Krista L. Lentine,

• Alhamad, Tarek, Washington University in St. Louis, St. Louis, Missouri, United States

Tarek Alhamad,

• Lam, Ngan, University of Alberta, Edmonton, Alberta, Canada

Ngan Lam,

• Naik, Abhijit S., None, Ann Arbor, Michigan, United States

Abhijit S. Naik,

• Koraishy, Farrukh M., Saint Louis University, Saint Louis, Missouri, United States

Farrukh M. Koraishy,

• Axelrod, David A, Lahey Hospital and Clinic, Burlington, Massachusetts, United States

David A Axelrod,

• Segev, Dorry L., Johns Hopkins University, Baltimore, Maryland, United States

Dorry L. Segev,

• Dharnidharka, Vikas R., Washington University School of Medicine, St Louis, Missouri, United States

Vikas R. Dharnidharka,

• Brennan, Daniel C., Washington University in St. Louis, St. Louis, Missouri, United States

Daniel C. Brennan,

• Schnitzler, Mark, Saint Louis Univ, St Louis, Missouri, United States

Mark Schnitzler,

Background

Currently, transplant centers vary in screening practices for marijuana use and requirements for abstinence in kidney transplant (KTx) recipients.

Methods

We examined billing claims for 52,689 Medicare-insured KTx recipients to identify diagnoses of cannabis dependence or abuse (CDOA, International Classification of Diseases-9 diagnosis codes 304.3, 305.2) in the year before and after KTx. Associations of CDOA with post-KTx death and graft failure (adjusted hazard ratio, 95% _LCL aHR 95% _UCL) were quantified by multivariate Cox regression including adjustment for recipient, donor and transplant factors, and propensity for CDOA.

Results

CDOA diagnoses were uncommon, found in 0.5% and 0.3% in the year before and after KTx, respectively. The likelihood of CDOA diagnosis before and after KTx declined with older recipient age, and was increased in men, African Americans, those with less than a college education and unemployed patients. After multivariate and propensity adjustment, CDOA in the year before KTx was not associated with increased risk of death or graft survival in the year after KTx (Fig 1A). However, CDOA in the first year post-KTx was associated with three-times the risk of death-censored graft failure (aHR _1.722.93_4.99) and 2.5-times the risk of all-cause graft loss (aHR _1.592.57_4.17) in the subsequent year (Fig 1B).

Conclusion

Diagnoses of CDOA are uncommon among KTX recipients, and likely reflect a select subgroup of cannabis users who reach clinical attention. While associations likely in part reflect associated conditions or behaviors, clinical diagnosis of CDOA in the year after transplant appears to have prognostic importance for subsequent allograft survival.

Funding

• NIDDK Support