Introduction: Substance use disorders (SUD) are common in liver transplant (LT) candidates. Poorer postLT outcomes in tobacco users have led programs to prohibit tobacco use preLT. Our study evaluated the impact of a policy prohibiting use of all tobacco products on LT listing initiated on 8/1/13 compared to outcomes with a prior restrictive tobacco policy.

Methods: Medical records of all adult LT candidates evaluated from 1/1/10- 7/31/13 (Era-1 restrictive) and 8/1/13-3/1/17 (Era-2 prohibited) were retrospectively reviewed. Urine toxicology tests were analyzed.

Results: 1446, 387, and 245 (Era-1) and 1434, 368 and 185 (Era-2) patients were evaluated, listed, and transplanted, respectively. At LT evaluation, mean age was 54 years, 58% male, and mean MELD was 15 with no differences in the 2 eras. However, alcoholic liver disease and NASH increased in Era-2 (23 to 29% and 8 to 14%; p<0.005), while viral hepatitis decreased (22 to 17.9%; p=0.005). Amongst those listed, urine toxicology screening (70% vs 76%), lifetime tobacco use (44% vs 48%), and detectable tobacco metabolites at LT evaluation (11% vs 13%) were comparable between groups. In addition, psychiatric disorder prevalence (14% vs 26%; p<0.005), SUD pharmacotherapy (1% vs 3%; p=0.02) and psychiatry referrals (9% vs 21%; p<0.05) were all significantly higher in Era-2 vs Era-1 listed patients. Lifetime marijuana use (19 to 36%, p=0.03), recent marijuana use (3 to 15%; p=0.01), and detectable marijuana metabolites (3.6 to 15%; p=0.03) were higher at LT evaluation among listed smokers from Era-2. Overall listing rate (63 to 50%, p<0.005) decreased with more patients declined for ongoing tobacco use (2.7 to 7.5%; p<0.005) in Era-2 while the mean time from evaluation to listing increased (95 vs 127 days; p<0.005).

Conclusions: Stringent smoking cessation policies increase detection and treatment of multiple psychosocial risks in LT candidates. The changing demographics of patients referred for LT evaluation with more frequent marijuana use and psychiatric co-morbidities may make it increasingly difficult to achieve full tobacco cessation prior to LT.

CITATION INFORMATION: Likhitsup A., Hassan A., Mellinger J., Askari F., Winder G., Sharma P., Saeed N., Sonnenday C., Fontana R. The Impact of a Tobacco Prohibition Policy Compared to a Restrictive Policy on Liver Transplant Candidate Outcomes Am J Transplant. 2017;17 (suppl 3).

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