*Purpose: The effect of marijuana (MJ) use on liver transplant (LTx) outcomes is unclear. We aimed to investigate the prevalence of MJ and cannabidiol (CBD) use among LTx recipients at the University of Colorado (UCH), and to characterize habits and predictors of use.

*Methods: LTx recipients followed at UCH as of July 2019 with valid email addresses were sent an informed consent postcard and survey invitation. The survey was conducted using REDCap. IBM SPSS Statistics software was used for chi-squared analysis on categorical variables and logistic regression for univariate and multivariable analysis.

*Results: 1,714 LTx recipients were identified at UCH; 1,227 had valid email addresses and were sent surveys. 538 people responded to the survey as least partially; 508 completed the survey entirely. The mean age of respondents was 59 years, with 63.7% male and 81.7% of Caucasian race. Hepatitis C (HCV) (30.4%) and alcohol use (17.7%) were the most common etiologies of liver disease. 71.9% were residents of Colorado. Among respondents, 23.8% reported current MJ use and 25.2% reported former MJ use. Of current users, 75.2% used the traditional plant form of MJ. Methods of use included smoking (72.4%), ingestion (55.3%) and vaporization (31.7%). 46.8% of current users reported daily MJ use, and 64.2% reported use prior to LTx. Top reasons for MJ use were recreational (56.5%), anxiety (54.8%), pain (53.2%), nausea (25.0%), and insomnia (21.8%). Among respondents, 21.0% were current users of CBD and 6.0% were former users. The most common forms of CBD use were creams or lotions (58.9%), edibles (29.0%), and oils (29.0%). Of current CBD users, 42.1% used CBD less than one day a week while 23.4% used CBD daily. The most common reasons for CBD use were pain (84.9%), anxiety (31.1%), nausea (13.2%), and sleep (10.4%). Among current MJ users, 51.6% also reported current CBD use. In multivariable analysis, age (OR 0.941, 95% CI 0.923-0.959, p= 0.000), diabetes (OR 0.357, 95% CI 0.171-0.746, p= 0.006), HCV cirrhosis (OR 3.949, 95% CI 2.281-6.835, p= 0.000), alcoholic cirrhosis (OR 2.101, 95% CI 1.202-3.671, p= 0.009), and current tobacco use (OR 2.918, 95% CI 1.065-7.990, p= 0.037) were significant predictors of MJ use.

*Conclusions: Our study shows that MJ use after LTx is common (23.8%). Most (72.4%) smoke it and daily use is frequent (46.8%). Anxiety, pain and recreation were top reasons for its use. MJ use is associated with decreasing age, alcoholic and HCV cirrhosis, and tobacco use. Further studies are clearly needed.

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