*Purpose: Gabapentinoid are commonly used to manage neuropathic pain in recipients with kidney transplantation (KT), with increasing concerns of co-prescribing with opioids and benzodiazepines leading to higher mortality risk. We aimed to examine secular trends in prescribing gabapentinoids and co-prescribing opioids or benzodiazepines with gabapentinoids among KT recipients.

*Methods: Using USRDS and Medicare claims, we studied adults (aged≥18) who received KT between 2006-2017 with Medicare Part D at the time of KT. Co-prescription of opioids or benzodiazepines with gabapentinoids was defined as having filled opioids or benzodiazepines prescriptions within 7 days of the date of dispensing gabapentinoids. We calculated the percentage of patients with the prescription during 1 year post-KT, stratified by year at KT and demographic factors (age, sex, race, and diabetes). Then, we used Cox regression to quantify the risk of mortality by gabapentinoids prescription.

*Results: Of 63,359 KT recipients, 13.4% filled at least one gabapentinoids prescription within 1 year post-KT. The percentage of KT recipients with gabapentinoids prescription during the first year of KT increased over time (9.6% in 2006 vs. 16.2% in 2017). Recipients with age 40 to 64, female, White, and those with diabetes were likely to be prescribed with gabapentinoids. Of the 8,509 recipients with gabapentinoids prescription, 45.3% was co-prescribed with opioids, 7.4% was co-prescribed with benzodiazepines, and 3.3% was co-prescribed with both opioids and benzodiazepines. Recipients with no gabapentinoids prescription had lower mortality risk (adjusted hazard ratio [aHR]=_0.790.84_0.90) and those co-prescribed gabapentinoids with either opioids or benzodiazepines had higher mortality risk (aHR=_1.201.31_1.43) compared with recipients with gabapentinoids prescription.

*Conclusions: Among KT recipients, gabapentinoids prescription has increased over time with higher co-prescription with opioids or benzodiazepines, which were associated with increased mortality.

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