Marijuana Consumption in Liver Transplant Recipients.

Marijuana is legalized for either medical or recreational use in over half of the states in the United States and in Canada, but many transplant centers will not list patients who are using marijuana. However, the effect of marijuana on transplant outcomes remains unclear. Thus, we performed a retrospective analysis of all adult (≥18 years old) liver transplant patients treated at our center between 2007 and 2017. Patients were grouped according to their marijuana use and tobacco smoking status. We also evaluated tobacco smoking status for the comparative evaluation. Posttransplant morbidity, mortality, and graft survival were evaluated. In total, 316 patients were included: 171 (54%) patients were tobacco smokers (70 current; 101 former), 81 (26%) patients were marijuana smokers (13 current; 68 former), and 64 (20#x0025;) patients were both marijuana and tobacco smokers. A total of 136 (43%) reported never smoking marijuana or tobacco. After adjustment, current tobacco users were over 3 times as likely to die within 5 years compared with never users (hazard ratio [HR], 3.25; 95% confidence interval [CI], 1.63-6.46; P < 0.001), but no difference was seen between current/former and never marijuana users (HR, 0.52; 95% CI, 0.26-1.04; P = 0.06). No significant differences in inpatient respiratory complications, reintubation, or >24-hour intubation was seen. Overall, pretransplant marijuana use, past or current, does not appear to impact liver transplant outcomes, though tobacco smoking remains detrimental.

Liver adenomatosis: serial investigation on MRI.

PURPOSE: To describe the natural history of liver adenomatosis (LA), including complications and changes in lesion size over time. MATERIALS AND METHODS: Eighteen patients with clinical diagnosis of LA were included. Clinical and biochemical information were collected. The initial and follow-up MR studies were reviewed retrospectively to determine change in lesion size and imaging features. RESULTS: Seventeen patients were women (94.4%). The mean age of the initial MR study was 37.0 years (18-52 years). The median size of the largest lesion was 6.7 cm (range 3.0-13.5 cm). Intratumoral bleeding was detected on MRI in 9 lesions, in 7 patients (38.8%). The median size for hemorrhagic lesions was 7.6 cm (range 4.1-13.5 cm). During the mean follow-up period of 29.4 (range 4-98) months, 10 patients had stable disease (55.6%), and 8 patients had tumor regression (44.4%). Of 8 patients who were followed without intervention, 3 patients (37.5%) had spontaneous regression. No malignant transformation or lesion progression was occurred. CONCLUSION: During an over 2-year follow-up period, the majority of lesions of LA appeared to remain stable or showed tumor regression. Spontaneous tumor regression can be observed in approximately 37% of individuals in the age range of 28-53 years.

Outcomes of patients with elevated α-fetoprotein level and initial negative findings at MR imaging.

PURPOSE: To evaluate interval cancer diagnosis in patients with elevated α-fetoprotein (AFP) level and initial negative findings at magnetic resonance (MR) imaging. MATERIALS AND METHODS: The institutional review board approved this HIPAA-compliant retrospective study and waived informed consent. Seventeen patients with elevated AFP levels (>300 ng/mL [>300 µg/L]) and initial negative findings at hepatic MR imaging from 2002 to 2011 were identified. MR reports, pathology reports, and medical records were reviewed to determine outcome, including identification of hepatocellular carcinoma (HCC), and track changes in serum AFP level. Initial and follow-up MR images were reviewed to evaluate presence and size of hepatic nodules. Significance of AFP values was tested with repeated-measures analysis of variance. RESULTS: Ten (59%) of 17 patients developed HCCs (13 tumors) after a mean of 138 days (range, 41-247 days). Nine (90%) of 10 patients with HCCs underwent follow-up MR imaging, and one patient (10%) underwent liver transplantation without MR follow-up. Of 12 HCCs in nine patients who underwent follow-up MR imaging, 10 (83%) were noted at follow-up MR imaging and two were found only at surgery. Mean diameter of visualized HCCs was 3.4 cm. Of 10 HCCs detected at follow-up MR imaging, five were identifiable in retrospect at initial MR studies (mean diameter, 1.4 cm). Serum AFP levels in patients with HCCs were significantly higher than those in patients without HCCs and progressively increased over time (P = .012). CONCLUSION: Subsequent HCCs in patients with elevated AFP levels and initial negative findings at MR imaging are relatively common and demonstrable during short follow-up. Close follow-up (serial 3-month studies) is recommended in the setting of a steady increase in AFP level.