Purpose: Policies for transplant eligibility for tobacco and marijuana (MJ) users vary among transplant centers. The aim of this study was to compare the impact of MJ use and tobacco use on kidney transplant recipient (KTR) outcomes.

Methods: KTRs at a single center from 2001-15 were reviewed for outcomes of all-cause graft loss, infection, biopsy proven acute rejection (BPAR), and eGFR between four groups: MJ only users, MJ and tobacco (MJ/Tobacco) users, tobacco only users, and non-users.

Results: The cohort (N=919) included 48 (5.2%) MJ users, 45 (4.8%) MJ/Tobacco users, 136 (14.7%) tobacco users, and 75% non-users. KTRs with any MJ use were younger, male, non-Caucasian, and previous users of other illicit drugs. In this cohort, no significant differences in eGFR or infection at one year were found, though logistic regression showed increased risk of pneumonia at one year in tobacco only users (OR 1.66, P = 0.027). No significant increase in the incidence of fungal pneumonia one-year post-transplant was noted between non-users (0.6%), MJ only users (0%), tobacco only users (1.5%), and MJ/Tobacco users (4.4%). BPAR at one year was greater among MJ only (31.3%), MJ/Tobacco (28.9%), and tobacco only users (25.5%) compared to non-users (17%, P=0.011). Medical adherence was notably lower in MJ only, MJ/Tobacco, and tobacco only user groups compared to non-users (87.5%, 90.4%, 84.4%, 93.8%, respectively). Compared to non-smokers, MJ/Tobacco and tobacco only users had significantly higher adjusted hazard ratio for risk of graft loss (aHR 1.71, P=0.031 and 1.55, P=0.004, respectively). No significant difference in graft loss was found among MJ only users compared to non-users (aHR 1.06, P=0.831).

Conclusion: Tobacco use alone or in combination with MJ increases risk of graft loss. Survival post-transplant was better than historical outcomes on dialysis. Our center does not deny transplant on the basis of MJ use alone, and this practice should be considered elsewhere.

CITATION INFORMATION: Fabbri K., Anderson-Haag T., Spenningsby A., Israni A., Nygaard R., Stahler P. Marijuana Use Should Not Preclude Consideration for Kidney Transplantation Am J Transplant. 2017;17 (suppl 3).

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