Opioids and Kidney Transplants

As a key stakeholder in the field of nephrology, Falcon continuously seeks to understand how to better support physicians and patients from ESRD to transplantation. Jody A. Charnow, Editor of Renal and Urology News, examines the correlation between opioid usage and its effect on transplantation success.

Article reposted from Renal and Urology News. Originally posted 5/2/17.

Opioid use before and after a kidney transplant may increase the risk of death and graft loss, investigators reported at the 2017 American Transplant Congress in Chicago. In a study of 75,430 kidney transplant recipients, Krista L. Lentine, MD, Ph.D., Professor of Medicine at Saint Louis University (SLU) in Saint Louis, Missouri, and colleagues examined the association between opioid use in the year before and after transplantation and patient and graft survival.Using a novel database, Dr. Lentine and her colleagues linked national transplant registry identifies for kidney transplant recipients to records from a large US pharmaceutical claims warehouse for the period 2008 – 2015). Prescription fills for opioids in the year prior to transplantation were normalized to morphine equivalents. Of the 75,430 patients in the study, 43.1% filled opioid prescriptions in the year prior to transplantation. Opioid use was more common among female, white, unemployed, and privately insured recipients and those with long pre-transplant dialysis duration.

In adjusted analyses, the highest-level opioid use (more than 1000 mg/day) was associated with a 45% and 28% higher risk of death and all-cause graft loss, respectively, in the first post-transplant year compared with no opioid use. Among recipients with the highest level of pre-transplant opioid use, 60% continued high-level use after transplantation, according to the investigators. High-level opioid use (above 600 mg per day) in the first year after transplantation was also associated with worse outcomes, with an approximately 2-fold higher risk of death and a 68% higher risk of all-cause graft loss over the following year.

“While associations may in part reflect underlying conditions or behaviors, opioid use history appears relevant in assessing and providing care to kidney transplant candidates and recipients,” Dr. Lentine, who is Medical Director for Living Kidney Donation at SLU’s Center for Transplantation, told Renal & Urology News.