Journal article
Associations of Pre-Transplant Prescription Narcotic Use with Clinical Complications after Kidney Transplantation
American journal of nephrology, Vol.41(2), pp.165-176
01/01/2015
DOI: 10.1159/000377685
PMCID: PMC4522162
PMID: 25832723
Abstract
Background: The impact of narcotic use before kidney transplantation on post-transplant clinical outcomes is not well described. Methods: We examined integrated national transplant registry, pharmacy records, and Medicare billing claims to follow 16,322 kidney transplant recipients, of whom 28.3% filled a narcotic prescription in the year before transplantation. Opioid analgesic fills were normalized to morphine equivalents (ME) and expressed as mg/kg exposures (approximate quartiles: 0.1-1.7, 1.8-5.4, 5.5-23.7, and = 23.8 mg/kg, respectively). Post-transplant cardiovascular, respiratory, neurological, accidents, substance abuse, and noncompliance events were identified using diagnosis codes on Medicare billing claims. Adjusted associations of ME level with post-transplant complications were quantifiedby multivariate Cox regression. Results: The incidence of complications at 3 years post-transplant among those with the highest pre-transplant ME exposure compared to no use included: ventricular arrhythmias, 1.1 vs. 0.2% (p < 0.001); cardiac arrest, 4.7 vs. 2.7% (p < 0.05); hypotension, 14 vs. 8% (p < 0.0001); hypercapnia, 1.6 vs. 0.9% (p < 0.05); mental status changes, 5.3 vs. 2.7% (p < 0.001); drug abuse/dependence, 7.0 vs. 1.7% (p < 0.0001); alcohol abuse, 1.8 vs. 0.6% (p = 0.0001); accidents, 0.9 vs. 0.3% (p < 0.05); and noncompliance, 3.5 vs. 2.3% (p < 0.05). In multivariate analyses, transplant recipients with the highest level of pre-transplant narcotic use had approximately 2 to 4 times the risks of post-transplant ventricular arrhythmias, mental status changes, drug abuse, alcohol abuse, and accidents compared with non-users, and 35-45% higher risks of cardiac arrest and hypotension. Conclusion: Although associations may reflect underlying conditions or behaviors, high-level prescription narcotic use before kidney transplantation predicts increased risk of clinical complications after transplantation. (C) 2015 S. Karger AG, Basel
Details
- Title: Subtitle
- Associations of Pre-Transplant Prescription Narcotic Use with Clinical Complications after Kidney Transplantation
- Creators
- Krista L. Lentine - Saint Louis UniversityNgan N. Lam - Western UniversityHuiling Xiao - Saint Louis UniversityJanet E. Tuttle-Newhall - Saint Louis UniversityDavid Axelrod - Dartmouth CollegeDaniel C. Brennan - Washington University in St. LouisVikas R. Dharnidharka - Washington University in St. Louis School of MedicineHui Yuan - Saint Louis UniversityMustafa Nazzal - Saint Louis UniversityJie Zheng - Saint Louis UniversityMark A. Schnitzler - Saint Louis University
- Resource Type
- Journal article
- Publication Details
- American journal of nephrology, Vol.41(2), pp.165-176
- Publisher
- Karger
- DOI
- 10.1159/000377685
- PMID
- 25832723
- PMCID
- PMC4522162
- ISSN
- 0250-8095
- eISSN
- 1421-9670
- Number of pages
- 12
- Grant note
- R01 DK102981; RC1 DK086450; R01DK102981; RC1-DK86450 / NIDDK NIH HHS; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK) R01DK102981 / NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK)
- Language
- English
- Date published
- 01/01/2015
- Academic Unit
- Surgery
- Record Identifier
- 9984322937102771
Metrics
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