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Survival implications of opioid use before and after liver transplantation
Journal article   Open access   Peer reviewed

Survival implications of opioid use before and after liver transplantation

Henry B Randall, Tarek Alhamad, Mark A Schnitzler, Zidong Zhang, Sophia Ford-Glanton, David A Axelrod, Dorry L Segev, Bertram L Kasiske, Gregory P Hess, Hui Yuan, …
Liver transplantation, Vol.23(3), pp.305-314
03/2017
DOI: 10.1002/lt.24714
PMID: 28027603
url
https://doi.org/10.1002/lt.24714View
Published (Version of record) Open Access

Abstract

Implications of prescription opioid use for outcomes after liver transplantation (LT) have not been described. We integrated national transplant registry data with records from a large pharmaceutical claims clearinghouse (2008‐2014; n = 29,673). Opioid fills on the waiting list were normalized to morphine equivalents (MEs), and exposure was categorized as follows: > 0‐2 ME/day (level 1), > 2‐10 ME/day (level 2), > 10‐70 ME/day (level 3), and >70 ME/day (level 4). Associations (adjusted hazard ratio [aHR], 95% LCL aHR 95% UCL) of pretransplant ME level with patient and graft survival over 5 years after transplant were quantified by multivariate Cox regression including adjustment for recipient, donor, and transplant factors, as well as propensity adjustment for opioid use. Overall, 9.3% of recipients filled opioids on the waiting list. Compared with no use, level 3 (aHR 1.061.281.55) and 4 (aHR 1.161.521.98) opioid use during listing were associated with increased mortality over 5 years after transplant. These associations were driven by risk after the first transplant anniversary, such that mortality >1‐5 years increased in a graded manner with higher use on the waiting list (level 2, aHR, 1.001.271.62; level 3, aHR, 1.081.381.77; level 4, aHR, 1.492.012.72). Similar patterns occurred for graft failure. Of recipients with the highest level of opioids on the waiting list, 65% had level 3 or 4 use in the first year after transplant, including 55% with use at these levels from day 90‐365 after transplant. Opioid use in the first year after transplant also bore graded associations with subsequent death and graft loss >1‐5 years after transplant. Opioid use history may be relevant in assessing and providing care to LT candidates.
 Registries Adolescent Adult Analgesics, Opioid - administration & dosage Analgesics, Opioid - adverse effects Analgesics, Opioid - therapeutic use End Stage Liver Disease - complications End Stage Liver Disease - mortality End Stage Liver Disease - surgery Female Graft Survival Humans Liver Transplantation Male Middle Aged Pain - drug therapy Pain - etiology Patient Selection Prescription Drugs - administration & dosage Prescription Drugs - adverse effects Prescription Drugs - therapeutic use Propensity Score Proportional Hazards Models Retrospective Studies Risk Factors Severity of Illness Index Survival Analysis Waiting Lists - mortality Young Adult

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