*Purpose: The opioid epidemic within the United States has devastated patients and their families in addition to triggering a national public health crisis. Unnecessary prescribing of opioids in the post-operative setting is a major contributor to narcotic exposure and harm. The purpose of this evaluation is to assess the impact of an opioid sparing protocol and post-operative pain education on the narcotic prescribing patterns in renal transplant (RTx) recipients upon discharge from the transplant admission.

*Methods: Adult renal transplant recipients from 01/2015 to 09/2018 were analyzed. Opioid sparing protocols were piloted in 2016 with wider implementation 10/2017. An educational in-service was given to all transplant nursing staff on pain assessment and management. Patient education was also revised to address patient expectations on post-operative pain management. Inpatient opioids were rapidly titrated and discontinued with the intention of utilizing acetaminophen for post-operative pain management on discharge from the transplant admission. Percent of patients discharged on opioids were compared pre- and post-protocol implementation. Opioids prescribing was also assessed across time and between open and robotic RTx.

*Results: Overall, 376 adult RTx patients were included. Patients were 63% male, 46% African American, and were an average of 50.8 (SD +13.5) years old (Table 1). A majority of patients underwent open RTx (60.3%) and received deceased donor RTx (53.5%). Opioid prescribing on transplant discharge was significantly lower after opioid minimization protocol and education (pre 68.3% vs. post 11.1%, p < 0.001). Transplant length of stay was significantly shorter post-opioid minimization protocol (p=0.03). There was no difference in opioid prescribing based on RTx surgery type pre (p=0.78) or post-protocol (p=0.33) implementation. Table 2 details outcome differences. Over time, there was a significant downtrend in opioid prescribing on discharge (Figure 1). If opioid therapy was required post-protocol, tramadol (7/13, 53.9%) was the predominant agent prescribed.

*Conclusions: Opioid minimization and non-opioid prescribing is feasible and well-tolerated within an adult RTx population with the proper patient and staff education.

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