Purpose: To determine the impact and correlation of pre-transplant chronic opiate use with post-transplant chronic opiate use, resource utilization, and patient survival in addition to identifying predictors for post-transplant outcomes in the setting of chronic opiate use.

Methods: This is an Institutional Review Board approved, retrospective, single-center chart review of adult kidney transplant recipients from September 1, 2012 to February 28, 2014. Patients who were less than 18 years of age and living outside the state of the study institution were excluded. A state-wide electronic controlled substance prescription record was used to quantify narcotic use before and after transplant. Univariate analysis of dichotomous variables was performed using the Fisher's Exact Test. Multivariate analysis was carried out using stepwise logistic regression. An alpha significance level of 5% was considered statistically significant.

Results: Of the 132 patients who underwent kidney transplant during the study period, 93 met inclusion criteria. Within the six months prior to transplant, 29 patients (31.2%) received prescriptions for opiate pain relievers. The presence of pre-transplant opiate use correlated with significant post-transplant opiate use (P=0.001). Significant use of opiates post-transplant also correlated with pre-transplant benzodiazepine use (P=0.02) and readmission within six months post-transplant (P=0.03). Pre-transplant opiate use also correlated with significant late use of opiates post-transplant (P=0.01). Only one patient was lost to follow up within 6 months post-transplant and patient survival 12 months post-transplant was 98.9%. These results were not statistically significant in terms of correlation with pre-transplant opiate use.

Conclusions: Kidney transplant recipients with a previous history of opiate use are more likely to continue opiate use in larger quantities after transplantation. Chronic opiate use prior to transplant did demonstrate a negative impact on readmission rates within six months post-transplant, but did not significantly impact patient survival. Future studies are warranted regarding the impact of chronic opiate use on morbidity and mortality outcomes in solid organ transplant recipients.

CITATION INFORMATION: Evans R, Neville N, Fugit A, Gedaly R, Clifford T. Predictors of Outcomes After Kidney Transplantation in the Setting of Chronic Opiate Use. Am J Transplant. 2016;16 (suppl 3).

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