*Purpose: Impact of pre-liver transplant opioid use on post-liver transplant length of stay and clinical outcomes.

*Methods: This single-institution retrospective study included adult patients who received a liver transplant between April 2015 and November 2018. Exclusion criteria included multi-organ transplant and/or re-transplant recipients. Patients were divided into two groups: those taking opioid medications and those not taking opioid medications prior to transplantation. The primary endpoint was length of stay during the index transplant admission. The secondary endpoints compared opioid use at months 1, 3, 6, 9, and 12, patient 1-year mortality rate, 1-year graft failure rate, rejection within 1 year of transplant, ileus and small bowel obstruction during transplant admission, unplanned return to the operating room during transplant admission, and 1-month and 3-month readmission rates.

*Results: Three hundred patients met our inclusion criteria, including 243 who were not taking opioids prior to transplantation and 57 who were taking opioids prior to transplantation. Most patients included in the study were male (65%) deceased donor recipients (86.3%) with a median age of 59 and median MELD of 25 at the time of transplant. There were no statistically significant differences between the two groups. There was no statistically significant difference in length of stay post-transplant with a median of 9 days in the no-opioid group compared to 10 days in the opioid group (p=0.42). There was a statistically significant difference of opioid use post-transplant at all time-points between the two groups (discharge and months 1, 3, 6, 9, and 12). There was no difference in the mortality rate (10.3% vs 8.8%, p=1), graft failure rate (2% vs 0%, p=0.59), and 1-year rejection rate (10.5% vs 7%, p=0.62). There was no difference in ileus, small bowl obstruction, or unplanned return to the operating room. Similar readmission rates were seen between the two groups within 1 month (28.4% vs 31.6%, p=0.745) and 3 months (43.5% vs 45.6%, p=0.882).

*Conclusions: There was no significant impact of pre-transplant opioid use on length of stay, mortality, graft failure, rejection, or 1- and 3-month readmissions. We noted a strong correlation with patients who used opioids pre-transplant being more likely to continue using opioids post-transplant at all time periods examined. We noted a trend towards higher pre-transplant morphine equivalents resulting in higher opioid doses and longer duration of opioid use post-transplant. Further investigation is required to examine the impact of pre-transplant opioid use on long-term clinical outcomes.

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