The debate about marijuana usage in transplant candidates: recent medical evidence on marijuana health effects
The debate about marijuana usage in transplant candidates: recent medical evidence on marijuana health effects
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关于移植候选人使用大麻的争论：关于大麻健康影响的最新医学证据
DOI：
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发表时间：
2008
影响因子：
2.2
通讯作者：
K. Coffman
中科院分区：
文献类型：
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作者：
K. Coffman
审查目的大麻是目前世界上使用最广泛的非法物质。如何处理积极使用大麻的移植候选人的问题是移植选择委员会经常遇到的问题。最近的研究发现，使用大麻的相关因素包括使用其他非法物质的风险增加，情感障碍和精神病的风险增加，以及认知和运动技能受损。真菌感染的风险和对细胞免疫的可能影响也可能增加癌症风险。讨论了大麻实验室检测的可靠性。隐形过氧化物酶可能出现假阴性，依非韦伦（Sustiva）可能出现假阳性。光度免疫测定法（发射）有3%的假阳性率。使用20 ng/ml的截止点并通过GC/MS确认，将在检测大麻滥用方面提供“几乎100%可靠的准确性”。该问题的管理指南应基于大麻对健康影响的客观医学证据，以及在医疗紧急情况可能推动医疗决策的移植环境中的影响。最近对16个学术移植中心的调查显示，在列出移植候选人之前，对禁欲时间的指导方针几乎没有达成共识。
Purpose of reviewCannabis is currently the most widely used illicit substance in the world. The issue of how to handle transplant candidates with active use of cannabis is a commonly encountered one for transplant-selection committees. Recent findingsCorrelates of marijuana use include increased risk of use of other illicit substances, increased risk of affective disorders and psychosis, as well as impaired cognition and motor skills. Risk of fungal infections and possible effects on cellular immunity that may increase cancer risk have also been reported. Reliability of laboratory testing for cannabis is discussed. False-negatives may occur with stealth peroxidases and false-positives with efavirenz (Sustiva). Photometric immunoassay (EMITS) has a 3% false-positive rate. Using a cutoff point of 20 ng/ml with confirmation via GC/MS will give a ‘virtually 100% reliable accuracy’ in detecting cannabis abuse. SummaryGuidelines on management of the problem should be based on objective medical evidence on the health effects of marijuana, as well as on the implications in the transplant setting where medical urgency can drive medical decision-making. A recent survey of 16 academic transplant centers showed little consensus on guidelines for length of abstinence prior to listing candidates for transplantation.