Background: Excess opiate prescribing has led to an epidemic, and evidence to guide abdominal transplant practice is lacking. We aimed to identify variation in opiate prescribing at discharge across transplant centers.

Methods: Using retrospective cohort data from three academic transplant centers from 2014 – 2017, we evaluated clinical and pharmacy data to study prescribing patterns in kidney transplant (KT), liver transplant (LT), and simultaneous liver-kidney transplant (SLK) recipients. Opiate quantities were converted to oral morphine equivalents (OME). 200 OME is the recommended standard for abdominal surgery. Bivariate statistics were used for analysis.

Results: Of 3083 patients (70.4 % KT (n=2171), 27.0% LT (n=832), 2.6% SLK (n=80)), 95.9% received opiates at hospital discharge, with a median of 300 OME (IQR 225-375) (Table 1). 20.1% were opiate tolerant (n=619, 7.9% KT, 31.9% LT, 35% SLK, p<0.001), which was associated with need for opiate refills (43.2% KT, 70.4% LT, 65.1% SLK).

In LT and SLK, more opiates were prescribed to tolerant patients vs non-tolerant (median OME 375 vs 337.5, p<0.001), but not in KT. Transplant centers varied significantly in opiate prescribing patterns for the same procedures. LT and SLK patients were prescribed more OME than KT patients overall and within each center (median OME LT and SLK 337.5 vs. KT 300, p<0.001). For LT and SLK, across centers, there were significant differences in amount of opiates prescribed (median OME, 300-375, p<0.001) and opiate refills (54.4-69.2%, p<0.001), despite similar rates of opiate tolerance (overall 31.7%, p=0.98). For KT, centers varied significantly in prescribing any opiates (p<0.001), amount prescribed (median OME 225-375, p<0.001), and opiate refills (19.3-38.2%, p<0.001), despite similar rates of opiate tolerance (7.4-9.1%, p=0.39).

Conclusions: More than 75% of abdominal transplant recipients were overprescribed opiates across three centers, with wide variation observed both between and within procedure types. Further study on opiate use in the post-transplant setting will improve transplant surgical care, and minimize the role of transplant surgery in the opiate crisis.

CITATION INFORMATION: Mathur A., Ubl D., Harbell J., Croome K., Taner C., Heimbach J., Moss A., Habermann E. Variation in Post-Transplant Opiate Prescribing Patterns across Transplant Centers Am J Transplant. 2017;17 (suppl 3).

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