Opioid use practices of kidney transplant centers in the United States: A national survey of institutional practices

Abstract

BackgroundThe opioid epidemic in the United States and the known risks of opioid utilization highlight the need for a better understanding of pain management around kidney transplantation. Although studies have been recently published describing efforts to minimize opioid therapy, clinical practices across the U.S. remain unknown.ObjectiveThe primary outcome of this study was to describe the programmatic use of opioids in the perioperative timeframe and upon discharge after kidney transplantation in the U.S.MethodsThis study was a cross‐sectional survey of transplant pharmacists to evaluate the national landscape of opioid management with regard to pretransplant candidacy, perioperative pain management, and posttransplant pain management. A 25‐question survey was distributed to members of transplant pharmacy listservs within the U.S. in March 2020.ResultsSixty‐three of 208 (30.3%) adult kidney transplant centers responded to the survey. The majority of institutions would actively list patients on an opioid (84.1%, 53/63) or medication for opioid use disorder (MOUD) (58.2%, 32/55). The majority of institutions (84%) utilized opioids for first‐line postoperative pain management in opioid‐naïve patients. More than half of the centers (55%) did not differentiate the postoperative pain regimen between opioid‐naïve and opioid‐experienced patients. A total of 72.6% of institutions prescribed opioids upon discharge from transplant, and 10.8% of the institutions prescribed subsequent opioid analgesics in the outpatient setting. Most (82.7%) of responders reported that their institutions did not have a written protocol or policy for posttransplant pain management.ConclusionThis survey highlights the existence of significant practice heterogeneity regarding opioid and MOUD utilization across kidney transplant programs in the U.S. Thus, transplant pharmacists have the opportunity within the context of their multidisciplinary team to develop multimodal pain management strategies to minimize opioid use while maintaining adequate pain control in kidney transplant candidates and recipients to continue to optimize patient care.