Opioid Prescription, Morbidity, and Mortality in US Transplant Recipients

Abbott, Kevin C.; Fwu, Chyng‐Wen; Eggers, Paul W.; Eggers, Anne W.; Kline, Prudence P.; Kimmel, Paul L.

doi:10.1097/tp.0000000000002057

Cited by 35 publications

(42 citation statements)

References 32 publications

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“…Online supplementary Table 2 shows the list of medications that we categorized as analgesics. Comorbidities ascertained from the CMS Form 2728 included congestive heart failure, peripheral vascular disease, cerebrovascular disease, current smoker status, atherosclerotic heart disease, diabetes, and AIDS [6,8]. Medicare inpatient billing data were used to identify diagnoses of…”

Section: Exposure Variablesmentioning

confidence: 99%

“…Numerous studies in the end-stage renal disease (ESRD) population have shown that pain is highly prevalent and debilitating [1][2][3], associated with poor perception of quality of life [4] and increased opioid prescription rates over time [5]. We and others have shown opioid prescriptions in the ESRD population are associated with adverse health outcomes including mortality, dialysis discontinuation, hospitalizations, altered mental status, falls, and fractures, as in the general population [6][7][8]. In response to the opioid epidemic, federal regulatory agencies have mandated and implemented strategies to limit opioid use and identify alternative medications for appropriate treatment of pain [9].…”

Section: Introductionmentioning

confidence: 99%

“…Future research should prospectively investigate the potential harms of such drugs and identify safer alternatives for treatment of pain in end-stage renal disease patients. cancer, whether patients had at least one pain-related hospitalization and the number of hospitalizations in 2010 [6,8].…”

mentioning

confidence: 99%

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Concomitant Use of Gabapentinoids with Opioids Is Associated with Increased Mortality and Morbidity among Dialysis Patients

et al. 2020

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Background: The opioid epidemic is a public health emergency and appropriate medication prescription for pain remains challenging. Physicians have increasingly prescribed gabapentinoids for pain despite limited evidence supporting their use. We determined the prevalence of concomitant gabapentinoid and opioid prescriptions and evaluated their associations with outcomes among dialysis patients. Methods: We used the United States Renal Data System to identify patients treated with dialysis with Part A, B, and D coverage for all of 2010. Patients were grouped into 4 categories of drugs exposure status in 2010: (1) no prescriptions of either an opioid or gabapentinoid, (2) ≥1 prescription of an opioid and no prescriptions of gabapentinoids, (3) no prescriptions of an opioid and ≥1 prescription of gabapenbtinoids, (4) ≥1 prescription of both an opioid and gabapentinoid. Outcomes included 2-year all-cause death, dialysis discontinuation, and hospitalizations assessed in 2011 and 2012. Results: The study population included 153,758 dialysis patients. Concomitant prescription of an opioid and gabapentin (15%) was more common than concomitant pre-scription of an opioid and pregabalin (4%). In adjusted analyses, concomitant prescription of an opioid and gabapentin compared to no prescription of either was associated with increased risk of death (hazard ratio [HR] 1.16, 95% CI 1.12-1.19), dialysis discontinuation (HR 1.14, 95% CI 1.03-1.27), and hospitalization (HR 1.33, 95% CI 1.31-1.36). Concomitant prescription of an opioid and pregabalin compared to no prescription of either was associated with increased mortality (HR 1.22, 95% CI 1.16-1.28) and hospitalization (HR 1.37, 95% CI 1.33-1.41), but not dialysis discontinuation (HR 1.13, 95% CI 0.95-1.35). Prescription of opioids and gabepentinoids compared to only being prescribed opioids was associated with higher risk of hospitalizations, but not mortality, or dialysis discontinuation. Conclusions: Concomitant prescription of opioids and gabapentinoids among US dialysis patients is common, and both drugs have independent effects on outcomes. Future research should prospectively investigate the potential harms of such drugs and identify safer alternatives for treatment of pain in end-stage renal disease patients. cancer, whether patients had at least one pain-related hospitalization and the number of hospitalizations in 2010 [6,8].

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Section: Exposure Variablesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Concomitant Use of Gabapentinoids with Opioids Is Associated with Increased Mortality and Morbidity among Dialysis Patients

et al. 2020

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“…Previous studies have shown that patients treated with opioids may have worse long‐term outcomes than patients not taking these drugs . In addition, high doses of opioids have been linked to worse outcomes in chronic disease patients, such as those on long‐term hemodialysis and kidney transplant recipients . In addition, Randall et al reported worse LT outcomes in association with opioid use.…”

Section: Discussionmentioning

confidence: 99%

“…Using scientific registry of transplant recipient data and by linking it to billing claims, Randal et al showed that higher dose of opioids among waitlisted patients for LT has been associated with higher 5 years post‐LT mortality compared to non‐opioid users. Long‐term prescription opioid treatment has resulted in higher incidence of allograft loss and increased mortality compared to no or short‐term treatment . Moreover, increased healthcare utilization has been reported among liver disease patients with pain and an opioid prescription; however, this assessment was performed at a single point in the natural history of cirrhosis .…”

Section: Introductionmentioning

confidence: 99%

Effect of opioid treatment on clinical outcomes among cirrhotic patients in the United States

Ali

Jiang

Agbim

et al. 2020

Clinical Transplantation

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Background Opioid medications are frequently used to address pain among patients with cirrhosis, including those on the liver transplant (LT) waitlist and after transplantation. However, opioid use has been associated with poor allograft outcomes and reduced transplant survival. We examined the impact of opioid use across the spectrum of advanced liver disease, from the initial hepatology consultation for cirrhosis through transplant referral, listing, and the post‐LT process. Methods The study includes all patients referred for cirrhosis management in a single healthcare system in the United States. Data were extracted retrospectively through medical chart review. Results Of 414 patients included in the study, 104 (25%) were treated with opioid. Patients on opioids were more likely to be White, have body mass indices (BMI) >30, have HCV, suffer from hepatic encephalopathy, cigarette smokers, and use benzodiazepines concurrently. Higher doses of opioids were associated with multiple emergency department (ED). Eighty‐nine underwent LT, including 20 opioid‐treated patients. There was no difference found between the opioid and non‐opioid groups with regard to allograft loss, ED visits, and hospital readmissions at 2 years post‐LT follow‐up. Conclusions Opioid treatment was common among patients with cirrhosis. We did not find increased negative outcomes among opioid users across the spectrum of cirrhosis. However, the sample for LT patients was small.

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Long-term Outcomes Following a Comprehensive Quality Assurance and Process Improvement Endeavor to Minimize Opioid Use After Kidney Transplant

et al. 2023

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ImportanceOpioid use following kidney transplant is associated with an increased risk of graft loss and mortality. Opioid minimization strategies and protocols have shown reductions in short-term opioid use after kidney transplant.ObjectiveTo evaluate the long-term outcomes associated with an opioid minimization protocol following kidney transplant.Design, Setting, and ParticipantsThis single-center quality improvement study evaluated postoperative and long-term opioid use before and after the implementation of a multidisciplinary, multimodal pain regimen and education process in adult kidney graft recipients from August 1, 2017, through June 30, 2020. Patient data were collected from a retrospective chart review.ExposuresPreprotocol and postprotocol implementation use of opioids.Main Outcomes and MeasuresBetween November 7 and 23, 2022, opioid use before and after protocol implementation was evaluated up to 1 year after transplant using multivariable linear and logistic regression.ResultsA total of 743 patients were included, with 245 patients in the preprotocol group (39.2% female and 60.8% male; mean [SD] age, 52.8 [13.1 years]) vs 498 in the postprotocol group (45.4% female and 54.6% male; mean [SD] age, 52.4 [12.9 years]). The total morphine milligram equivalents (MME) in the 1-year follow-up in the preprotocol group was 1203.7 vs 581.9 in the postprotocol group. In the postprotocol group, 313 patients (62.9%) had 0 MME in the 1-year follow-up vs 7 (2.9%) in the preprotocol group (odds ratio [OR], 57.52; 95% CI, 26.55-124.65). Patients in the postprotocol group had 99% lower odds of filling more than 100 MME in the 1-year follow-up (adjusted OR, 0.01; 95% CI, 0.01-0.02; P &lt; .001). Opioid-naive patients postprotocol were one-half as likely to become long-term opioid users vs preprotocol (OR, 0.44; 95% CI, 0.20-0.98; P = .04).Conclusions and RelevanceThe study’s findings show a significant reduction in opioid use in kidney graft recipients associated with the implementation of a multimodal opioid-sparing pain protocol.

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Opioid Prescription, Morbidity, and Mortality in US Transplant Recipients

Cited by 35 publications

References 32 publications

Concomitant Use of Gabapentinoids with Opioids Is Associated with Increased Mortality and Morbidity among Dialysis Patients

Concomitant Use of Gabapentinoids with Opioids Is Associated with Increased Mortality and Morbidity among Dialysis Patients

Effect of opioid treatment on clinical outcomes among cirrhotic patients in the United States

Long-term Outcomes Following a Comprehensive Quality Assurance and Process Improvement Endeavor to Minimize Opioid Use After Kidney Transplant

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