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Abstract: FR-PO1204

Association Between Post-Transplant Opioid Use and Immunosuppressant Therapy Adherence Among Renal Transplant Recipients

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical


  • Chisholm-Burns, Marie, University of Tennessee Health Science Center College of Pharmacy, Memphis, Tennessee, United States
  • Spivey, Christina Alease, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Potukuchi, Praveen Kumar, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Streja, Elani, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Kalantar-Zadeh, Kamyar, University of California Irvine, School of Medicine, Orange, California, United States
  • Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Molnar, Miklos Zsolt, University of Tennessee Health Science Center, Memphis, Tennessee, United States

Little is known about the effect of post-renal transplant opioid use on adherence to immunosuppressant therapy (IST).


Longitudinal data were analyzed from a retrospective cohort study examining US veterans undergoing renal transplant from October 1, 2007 through March 31, 2015. Opioid prescriptions dosages were collected and divided based on annual morphine milligram equivalent (AMME) within a year of transplant. Proportion of days covered of at least 80% indicated adherence to tacrolimus. We used logistic regression analyses to examine the association between posttransplant opioid use and adherence to IST.


Compared to renal transplant recipients (RTRs) without opioid usage, RTRs with opioid usage had lower probability of being adherent to tacrolimus in unadjusted and multivariable adjusted models (model 2-5) [Figure]. In the adjusted Model 5, RTRs with AMME opioid dose of 1-30 [OR (95% CI): 0.17 (0.05-0.56)], 31-60 [OR (95% CI): 0.21 (0.06-0.74)], and >60 [OR (95% CI): 0.18 (0.05-0.61)] had lower probability of tacrolimus nonadherence compared to RTRs without opioid usage.


RTRs who use prescription opioids during the first year posttransplant are less likely to be adherent to tacrolimus. Future studies are needed to better understand underlying causes of the association between opioid use and tacrolimus nonadherence.

Figure: Association of one-year posttransplant opioid AMME dose with tacrolimus adherence in unadjusted models (Model 1) in 1,229 RTRs and adjusted models (Models 2-5) in 1,068 RTRs.
Overall, Any opioid use; AMME dose categories, 1-30, 31-60, >60; Reference, No opioid use.
Model 1: unadjusted; Model 2: demographic characteristics; Model 3: model 2 variables plus comorbidities and smoking status; Model 4: model 3 variables plus medications; Model 5: model 4 variables and systolic/diastolic blood pressure and body mass index.


  • NIDDK Support