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The Impact of a Tobacco Prohibition Policy Compared to a Restrictive Policy on Liver Transplant Candidate Outcomes

A. Likhitsup,1 A. Hassan,1 J. Mellinger,1 F. Askari,1 G. Winder,2 P. Sharma,1 N. Saeed,3 C. Sonnenday,4 R. Fontana.1

1Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI
2Department of Psychiatry, University of Michigan, Ann Arbor, MI
3Department of Internal Medicine, Beaumont Hospital, Dearborn, MI
4Department of Surgery, University of Michigan, Ann Arbor, MI.

Meeting: 2018 American Transplant Congress

Abstract number: C224

Keywords: Liver transplantation, Negative selection, Outcome, Screening

Session Information

Date: Monday, June 4, 2018

Session Name: Poster Session C: Liver: Recipient Selection

Session Time: 6:00pm-7:00pm

 Presentation Time: 6:00pm-7:00pm

Location: Hall 4EF

Related Abstracts
  • Comparison of Tobacco Consumption versus Marijuana Consumption in Liver Transplant Recipients
  • Assessing the Impact of the Share35 Liver Allocation Policy: Survival Outcomes Among Liver Re-Transplant Recipients.

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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To cite this abstract in AMA style:

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 [abstract]. https://atcmeetingabstracts.com/abstract/the-impact-of-a-tobacco-prohibition-policy-compared-to-a-restrictive-policy-on-liver-transplant-candidate-outcomes/. Accessed March 8, 2021.

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