Kidney Week

Abstract: TH-PO988

Prescription Opioid before and after Kidney Transplant

Session Information

• Transplant Recipient Education, Adherence, and Novel Risk Factors for Graft Loss
  November 02, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Transplantation

• 1702 Transplantation: Clinical and Translational

Authors

• Lam, Ngan, University of Alberta, Edmonton, Alberta, Canada

Ngan Lam,

• Lentine, Krista L., Saint Louis University, St. Louis, Missouri, United States

Krista L. Lentine,

• Zhang, Zidong, Saint Louis University, St. Louis, Missouri, United States

Zidong Zhang,

• Segev, Dorry L., Johns Hopkins University, Baltimore, Maryland, United States

Dorry L. Segev,

• Dharnidharka, Vikas R., Washington University School of Medicine, St Louis, Missouri, United States

Vikas R. Dharnidharka,

• Hess, Gregory P., LDI University of Pennsylvania/IMS, Plymouth Meeting, Pennsylvania, United States

Gregory P. Hess,

• Devraj, Radhika, Southern Illinois University Edwardsville, Edwardsville, Illinois, United States

Radhika Devraj,

• Kasiske, Bertram L., Hennepin County Medical Center, Minneapolis, Minnesota, United States

Bertram L. Kasiske,

• Brennan, Daniel C., Washington University in St. Louis, St. Louis, Missouri, United States

Daniel C. Brennan,

• Schnitzler, Mark, Saint Louis Univ, St Louis, Missouri, United States

Mark Schnitzler,

Background

An evolving body of literature suggests the epidemic of prescription opioid use has impacted the transplant population.

Methods

We examined a novel database wherein national U.S. transplant registry identifiers were linked to records from a large pharmaceutical claims warehouse (2008 to 2015) to characterize antidepressant use before and after kidney transplantation, and associations (adjusted hazard ratio, _{95% LCL}aHR_{95% UCL}) with death and graft failure.

Results

Among 75,430 eligible patients, 43.1% filled opioids in the year before kidney transplantation, and use was more common among recipients who were women, white, unemployed, publicly insured, and those with longer pre-transplant dialysis. The majority of recipients (60%) with the highest level of pre-transplant opioid use continued high-level usage post-transplant. Pre-transplant opioid use bore graded associations with 1-year post-transplant outcomes, with the highest level use predicting 45% increased risk of death (aHR _1.281.45_1.66) and 28% increased risk of all-cause graft failure (aHR _1.171.28_1.41). High-level opioid use in the first year after transplant was associated with twice the risk of death (aHR _1.932.24_2.60) and 68% higher risk of all-cause graft failure (aHR _1.501.68_1.89) over the subsequent year.

Conclusion

While associations may, in part, reflect underlying conditions or behaviors, opioid use history appears relevant in assessing and providing care to transplant candidates and recipients.

Figure. Adjusted associations of Level 1-4 prescription opioid use before and after transplant and death and graft failure (referent=no use). Abbreviations: ACGF, all-cause graft failure; CI, confidence interval; DCGF, death-censored graft failure.

Funding

• NIDDK Support