Cannabis users needed more opioids in the first 48 hours after liver transplant, but this did not translate to worse outcomes for hospital stay, readmission, or mortality.
Transplant candidates who use cannabis, transplant providers, and policy analysts.
No difference in 90-day readmission or mortality
What the researchers found
Among 4,236 patients, cannabis users required significantly more opioids in the 48 hours after transplant (p=0.04). No significant differences in opioid use beyond 48 hours, discharge opioid prescriptions, hospital or ICU length of stay, 90-day readmission, or 90-day mortality.
Why it matters
Some transplant centers still consider cannabis use a barrier to eligibility. This data supports growing evidence that pre-transplant cannabis use does not worsen outcomes.
The numbers in context
4,236 patients. Higher opioids at 48 hours (p=0.04). No difference at 72 hours (p=0.07) or 7 days (p=0.33). No difference in LOS (p=0.69), ICU LOS (p=0.94), readmission (p=0.66), or mortality (p=0.96).
How the study worked
Retrospective cohort of 4,236 patients evaluated for liver transplant (January 2013-July 2023). Cannabis use defined as positive urine toxicology within 90 days. Multivariable regression compared outcomes.
What this study cannot tell us
Single-center retrospective. Cannabis defined by single urine test. No data on type or frequency of use.
How to read the evidence
Moderate: large retrospective cohort with multivariable adjustment, but single-center and crude exposure measure.
When this study was published
Published in 2025, with data from 2013-2023.
The bigger picture
Cannabis use has historically been used to deny organ transplant listing. This study challenges those policies by showing no association with worse outcomes.
Questions still open
- Should transplant centers update policies?
- Why do cannabis users need more opioids immediately after surgery?
- Does the type of cannabis use matter for outcomes?
Common questions
Does cannabis use affect liver transplant outcomes?
Can cannabis users receive organ transplants?
Read the original research
Cannabis and liver transplant in the era of legalization: Effects of pretransplant cannabis use on postoperative opioid use and transplant outcomes.
Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, 31(11), 1398-1410
Citation
Runge, Ava; Loeb, Becca; Shui, Amy M; Fenton, Cynthia; Lai, Jennifer; Rubin, Jessica. (2025). Cannabis and liver transplant in the era of legalization: Effects of pretransplant cannabis use on postoperative opioid use and transplant outcomes.. Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, 31(11), 1398-1410. https://doi.org/10.1097/LVT.0000000000000585
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