Journal article
Prescription opioid use before and after kidney transplant: Implications for posttransplant outcomes
American journal of transplantation, Vol.18(12), pp.2987-2999
12/2018
DOI: 10.1111/ajt.14714
PMCID: PMC6119653
PMID: 29498196
Abstract
Evolving literature suggests that the epidemic of prescription opioid use affects the transplant population. We examined a novel database wherein national U.S. transplant registry records were linked to a large pharmaceutical claims warehouse (2007-2015) to characterize prescription opioid use before and after kidney transplant, and associations (adjusted hazard ratio,
aHR
) with death and graft loss. Among 75 430 eligible patients, 43.1% filled opioids in the year before transplant. Use was more common among recipients who were women, white, unemployed, publicly insured, and with longer pretransplant dialysis. Of those with the highest level of pretransplant opioid use, 60% continued high-level use posttransplant. Pretransplant opioid use had graded associations with one-year posttransplant outcomes; the highest-level use predicted 46% increased risk of death (aHR
1.46
) and 28% increased risk of all-cause graft failure (aHR
1.28
). Effects of high-level opioid use in the first year after transplant were stronger, predicting twice the risk of death (aHR
2.24
) and 68% higher all-cause graft failure risk (aHR
1.68
) over the subsequent year; increased risk persisted over five years. While associations may, in part, reflect underlying conditions or behaviors, opioid use history is relevant in assessing and providing care to transplant candidates and recipients.
Details
- Title: Subtitle
- Prescription opioid use before and after kidney transplant: Implications for posttransplant outcomes
- Creators
- K L Lentine - Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO, USAN N Lam - Division of Nephrology, University of Alberta, Edmonton, AB, CanadaA S Naik - Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, MI, USAD A Axelrod - Division of Transplantation, Department of Surgery, Lahey Clinic, Burlington, MA, USAZ Zhang - Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO, USAV R Dharnidharka - Transplant Nephrology, Washington University School of Medicine, St. Louis, MO, USAG P Hess - Symphony Health, Conshohocken, PA, USAD L Segev - Center for Transplantation, Johns Hopkins School of Medicine, Baltimore, MD, USAR Ouseph - Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO, USAH Randall - Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO, USAT Alhamad - Transplant Nephrology, Washington University School of Medicine, St. Louis, MO, USAR Devraj - School of Pharmacy, Southern Illinois University, Edwardsville, IL, USAR Gadi - Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO, USAB L Kasiske - Department of Medicine, Hennepin County Medical Center, Minneapolis, MN, USAD C Brennan - Center for Transplantation, Johns Hopkins School of Medicine, Baltimore, MD, USAM A Schnitzler - Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO, USA
- Resource Type
- Journal article
- Publication Details
- American journal of transplantation, Vol.18(12), pp.2987-2999
- DOI
- 10.1111/ajt.14714
- PMID
- 29498196
- PMCID
- PMC6119653
- NLM abbreviation
- Am J Transplant
- ISSN
- 1600-6135
- eISSN
- 1600-6143
- Publisher
- United States
- Grant note
- HHSH250201000018C / HRSA HHS R01 DK096008 / NIDDK NIH HHS R01 DK102981 / NIDDK NIH HHS R01-DK096008 / NIDDK NIH HHS
- Language
- English
- Date published
- 12/2018
- Academic Unit
- Surgery
- Record Identifier
- 9984051511102771
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