Kidney Week

Abstract: FR-PO1201

Outcome Implications of Benzodiazepine and Opioid Co-Prescription in Kidney Transplant Recipients: A Pharmacoepidemiologic Analysis

Session Information

• Transplantation: Clinical - Immunosuppression, Adherence, Outcomes
  November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 1902 Transplantation: Clinical

Authors

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

Ngan Lam,

• Schnitzler, Mark, Saint Louis Univ, Shiloh, Illinois, United States

Mark Schnitzler,

• McAdams-DeMarco, Mara, Johns Hopkins, Baltimore, Maryland, United States

Mara McAdams-DeMarco,

• Hess, Gregory P., LDI University of Pennsylvania/Symphony Health, Wayne, Pennsylvania, United States

Gregory P. Hess,

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

Krista L. Lentine,

Background

Recent studies identify coprescription of benzodiazepines and opioids as a risk factor for adverse outcomes in the general population, but relationships have not been described among kidney transplant (KTx) recipients.

Methods

We examined a novel linkages of national registry data with records from a pharmaceutical claims warehouse (2008 to 2017) to characterize benzodiazepine and opioid use in the year after KTx and associations (adjusted hazard ratio, 95% _LCLaHR95%_UCL) with death >1 to 5 years post-KTx.

Results

Among 103,969 KTx recipients 15% filled benzodiazepines in the year after transplant: 6.3% long-acting, 7.5% short-acting, 1.8% both. Considered alone, benzodiazepine use in the first year posttransplant was associated with increased (P<0.05) mortality >1 to 5 yrs after KTx: aHR long-acting, _1.141.25_1.36; aHR short-acting, _1.331.44_1.56; aHR both, _1.411.64_1.91. Opioid use was higher in those who also filled benzodiazepines, especially both long- and short-acting (Fig A). Use of both medications was more common among recipients who were white, unemployed, and received prior KTx. There was also graded association of higher level opioid use with mortality that appeared additive with benzodiazepine coprescription (Fig. B). Patients who filled both classes of benzodiazepines and high-level opioids had 2.6-times mortality risk, compared to no use.

Conclusion

Benzodiazepines use is correlated with opioid fills after KTx, and these agents have additive associations on post-KTx mortality. Future work is needed to examine mechanisms of these associations and impact of reducing coprescription on improving outcomes after KTx.

Opioid Use by Benzodiazepine Use, and Associated Outcomes

Funding

• NIDDK Support