*Purpose: Opioid use after kidney transplant has been linked to poorer outcomes, and unused prescriptions can lead to potential misuse. Historical prescribing practice at our center was scheduled acetaminophen (APAP) and gabapentin for 72 hours and 28 tablets of APAP/codeine at discharge. A quality improvement (QI) evaluation of this practice showed that patients had a median of 26 unused opioid tablets at their 2-week follow up appointment and that 35% of patients had not required a single dose following hospital discharge. Based on these findings, we implemented a new postop pain protocol where all patients continued scheduled acetaminophen and gabapentin through POD10; only patients who required an opioid in the 24 hours leading up to discharge received a discharge opioid prescription for 10 tablets of tramadol 50 mg.

*Methods: This was a single center, retrospective, pre- and post- analysis of a QI project to optimize opioid use following kidney transplantation. Only solitary kidney transplants were included in our review.

*Results: We tracked 43 patients following the protocol change (post cohort) and compared to 28 patients transplanted immediately prior to the change (pre cohort). Baseline characteristics were similar between the two groups, and no differences in pre-transplant opioid exposure were observed (Table 1). Overall inpatient opioid utilization remained similar between groups, 4.9 MME/day pre vs 4.5 MME/day post (p=0.78). Discharge opioid prescriptions were significantly reduced from 100% pre to 28% post, P<0.001 (Figure 1). We identified one patient in the post cohort who required an opioid prescription after discharge.

*Conclusions: The current practice of only prescribing opioids at discharge among patients who needed opioids in the 24 hours prior to discharge is effective at reducing outpatient opioid prescriptions after kidney transplant.

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