*Purpose: Recent national policy changes make it imperative to implement practices to reduce opioid prescribing. Despite the importance, evidence to guide opioid utilization following kidney transplantation is lacking. The purpose of this study is to evaluate the implementation of an opioid restrictive post-operative pain management protocol in adult kidney transplant recipients (KTR).

*Methods: We analyzed patients who underwent kidney transplant at single center between 1/1/2017 to 8/15/2018. A standardized, opioid restrictive pain management protocol was implemented in February 2018 (Table 1). Patients were excluded if they received a simultaneous multi-organ transplant. The primary outcome was quantity of opioid tablets prescribed at discharge. Secondary outcomes included amount of opioid prescribed within first 30 days, number of patient calls for pain, and opioid prescription in electronic medical record (EMR) at 90 days and 1 year. Opioids were converted to oral morphine milligram equivalence (OME).

*Results: 179 KTRs were included (Table 2). After implementation, significantly less opioid tablets were prescribed at discharge (60 vs 4 tablets, p<0.001) and less OME were prescribed within 30 days of transplant (300 vs 38, p<0.001). Fewer patients received more than one opioid prescription in cohort 2 (14 vs 7, p<0.001). There was no difference in length of stay between groups, readmission rates at 30 and 90 days and number of patient calls for pain between groups. Significantly more patients received truncal block in cohort 2 (3 vs 19, p<0.001). All patients in cohort 1 received a PCA vs 5 in cohort 2 (p<0.001).

*Conclusions: A standardized, patient-centered pain management strategy after kidney transplantation reduced opioid prescribing without increasing readmissions or clinic calls. This data may be used to inform guidelines on appropriate OME prescribing for discharge after kidney transplantation.

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