October 21, 2025
2 min read
Key takeaways:
- The researchers found no association between cannabis use and graft failure.
- Time to wait-list approval was similar among cannabis users and nonusers.
Cannabis users experienced similar transplant evaluation and posttransplant outcomes as nonusers, indicating cannabis use alone should not be a wait-list consideration, according to data published in Kidney360.
Healio previously reported on cannabis use among patients on hemodialysis, which often goes unreported despite allowing opportunities to discuss appropriate dosage and reduce stigma.
Data derived from Kroll DS, et al. Kidney360. 2025;doi:10.34067/KID.0000000858.
With recreational cannabis use rising in the U.S., Syed Ali Husain, MD, MPH, transplant nephrologist and clinical investigator at Columbia University Irving Medical Center, and colleagues aimed to understand whether cannabis use directly impacted transplant evaluation consideration or posttransplant outcomes.
“Given the rising recreational use of cannabis — including 17% of all Americans and 26% of those age 18-34 — treating cannabis use as an absolute or relative contraindication to transplant may inappropriately decrease transplant access,” Husain and colleagues wrote.
The researchers reviewed records of 1,255 adult patients who began the transplant evaluation process at their center from 2016 to 2019. Active cannabis use was determined by self-reports from 8% of patients (mean age, 40 years; 74% men) compared with 92% nonusers (mean age, 56 years; 63% men).
Time to wait-listing approval served as the primary outcome, with graft failure serving as the secondary outcome.
Compared with nonusers, cannabis users were significantly more likely to complete their transplant evaluation (63% vs. 79%) and be approved for wait-listing (55% vs. 73%).
Forty-two percent of all patients received a transplant, including 65% of cannabis users and 40% of nonusers. No association was found between cannabis use and graft failure in both unadjusted and adjusted Cox proportional hazards model.
Additionally, cannabis use was associated with a faster rate of wait-list approval in the unadjusted model (HR = 1.73; 95% CI, 1.35-2.22), but this association lost significance when adjusted for age, sex, race and other demographic characteristics or comorbidities.
Overall, the researchers found cannabis users had similar evaluation and posttransplant experiences as nonusers, indicating use of the drug should not factor into a patient’s consideration on transplant waitlists.
Limitations included the reliance on self-reports, which did not specify how frequently cannabis was used by patients, and surveillance bias.
“These data indicate that cannabis users experience similar evaluation and transplant outcomes as nonusers and that cannabis use alone should not be considered a contraindication to referral or wait-listing,” Husain and colleagues wrote.
Perspective
Cannabis may help alleviate symptoms of kidney disease, but its use has historically been a contraindication for kidney transplantation, and policies vary widely by institution.
The evidence presented in this cohort from 2016 to 2019 suggests that active cannabis use did not reduce access to wait-listing (after adjustment) and did not show worse graft failure. But limitations caution us against generalizing. In New York, medical cannabis became available in 2016 but was limited to conditions typically not associated with kidney disease. Patients may have been reluctant to honestly self-report illegal recreational use that could have influenced kidney transplant eligibility at the time. After recreational cannabis was legalized in 2021 or after New York expanded its medical cannabis program in 2022, motivations for use and preference for certain products may have changed, likely influencing patient use and willingness to report it.
With growing cannabis use and evolving laws, excluding transplant candidates solely for cannabis use, especially when policies are inconsistently applied or lack strong evidence, raises concerns of fairness. Transplant criteria should distinguish between medical, recreational and problematic use. Despite federal illegality of cannabis hindering research, its use alone should not disqualify patients from transplant eligibility.
Joshua L. Rein, DO
Disclosures: Rein reports being employed by Veterans Affairs. The content of this article does not represent the views of the United States Department of Veterans Affairs or the United States Government.
Sources/Disclosures
Source:
Kroll DS, et al. Kidney360. 2025;doi:10.34067/KID.0000000858.
Disclosures:
Husain reports being a member of the National Kidney Foundation Transplant Advisory Council and the Scientific Registry of Transplant Recipients subcommittee, as well as serving as vice president for the New York Society of Nephrology. Please see the study for all other authors’ relevant financial disclosures.
