Abstract: TH-PO987

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

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • Lentine, Krista L., Saint Louis University , St. Louis, Missouri, United States
  • Schnitzler, Mark, Saint Louis Univ, St Louis, Missouri, United States
  • Alhamad, Tarek, Washington University in St. Louis, St. Louis, Missouri, United States
  • Lam, Ngan, University of Alberta, Edmonton, Alberta, Canada
  • Naik, Abhijit S., None, Ann Arbor, Michigan, United States
  • Koraishy, Farrukh M., Saint Louis University, Saint Louis, Missouri, United States
  • Axelrod, David A, Lahey Hospital and Clinic, Burlington, Massachusetts, United States
  • Segev, Dorry L., Johns Hopkins University, Baltimore, Maryland, United States
  • Dharnidharka, Vikas R., Washington University School of Medicine, St Louis, Missouri, United States
  • Brennan, Daniel C., Washington University in St. Louis, St. Louis, Missouri, United States
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 1.722.934.99) and 2.5-times the risk of all-cause graft loss (aHR 1.592.574.17) 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