A history of chronic opioid usage prior to kidney transplantation may be associated with increased mortality risk

Abstract

Chronic opioid usage (COU) for analgesia is common among patients with end-stage renal disease. In order to test whether a prior history of COU negatively affects post-kidney transplant outcomes, we retrospectively examined clinical outcomes in adult kidney transplant patients. Among 1064 adult kidney transplant patients, 452 (42.5%) reported the presence of various body pains and 108 (10.2%) reported a prior history of COU. While the overall death or kidney graft loss was not statistically different between patients with and without a history of COU, the cumulative mortality rate at 1, 3, and 5 years after transplantation, and during the entire study period, appeared significantly higher for patients with than without a history of COU (6.5, 18.5, and 20.4 vs. 3.2, 7.5, and 12.7%, respectively). Multivariate Cox regression analysis adjusted for potential confounding factors in entire cohorts and Cox regression analysis in 1:3 propensity-score matched cohorts suggest that a positive history of COU was significantly associated with nearly a 1.6- to 2-fold increase in the risk of death (hazard ratio 1.65, 95% confidence interval 1.04-2.60, and hazard ratio 1.92, 95% confidence interval 1.08-3.42, respectively). Thus, a history of chronic opioid usage prior to transplantation appears to be associated with increased mortality risk. Additional studies are warranted to confirm the observed association and to understand the mechanisms.

Prescription opioid use before and after kidney transplant: Implications for posttransplant outcomes

“…: kidney transplant recipients’ self-reported long-term opioid use before transplant was associated with a 2-fold higher risk of death but similar risk of graft loss; graft loss risk was not based on self-reported medication use but identified through chart review. (18) The kidney transplant evaluation period is an opportunity for the transplant team to review the candidate’s comorbid conditions and medication list to assess risks, and counsel and optimize care before surgery. Pretransplant opioid use may become more prevalent, since end-stage renal disease (ESRD) patients have multiple potential sources of acute and chronic pain, including underlying causes of ESRD (e.g., polycystic kidney disease), other comorbidity (e.g., diabetes mellitus), renal complications (e.g., calciphylaxis), and vascular access complications (e.g., steal syndrome with arteriovenous fistulas).…”

Associations of Pre-Transplant Prescription Narcotic Use with Clinical Complications after Kidney Transplantation

“…A single center study recently found associations of pre-transplant opioid use identified from chart review with post-transplant death [13], while we recently found associations of pre-transplant narcotic use defined by pharmacy fill records with increased risks of post-transplant death and graft loss in a larger national sample [14]. In the current study, we expanded our linkage of national transplant registry data and outpatient pharmacy fill records to incorporate Medicare billing claims as measures of clinical conditions diagnosed after transplantation.…”

“…Barrantes et al . performed a retrospective single-center study of 1064 kidney transplant recipients followed for a median of 48 months (interquartile range [IQR], 34 to 63), and found that 452 recipients (42%) had a history of chronic pain prior to transplantation and 108 (10%) reported chronic opioid use prior to transplantation [13]. In the adjusted analyses, recipients with a history of chronic opioid use had a 2-fold higher risk of death, but similar risk of graft loss compared to matched recipients without a history of chronic opioid use.…”

Recreational marijuana use is not associated with worse outcomes after renal transplantation

“…Cocaine and opioid abuse are usually absolute contraindications; tobacco and alcohol use or abuse are often relatively contraindicated. The use of these substances has been linked to graft loss, delayed graft function, and patient mortality . Any MJ use, on the other hand, is frequently banned as an absolute contraindication.…”