Background: Associations of narcotic use before kidney transplantation with post-transplant clinical outcomes are not well described.

Methods: We performed a retrospective analysis of linked national registry and pharmacy fill records in the United States to follow 16,322 kidney transplant recipients, of whom 4624 had evidence of a narcotic prescription filled in the year prior to transplantation. Opioid analgesic fills were normalized to morphine equivalents (ME) and expressed as mg/kg exposures (the 25th, 50th, and 74th percentiles of annual ME were 1.8, 5.5, and 23.7 mg/kg, respectively). We assessed the adjusted associations of pre-transplant ME level with post-transplant clinical outcomes.

Results: The incidence of complications among those with high-level pre-transplant ME exposure compared to no use at three-years post-transplant included: ventricular arrhythmias, 1.1% vs. 0.2% (p<0.001); cardiac arrest, 4.7% vs. 2.7% (p<0.05); hypotension, 14% vs. 8% (p<0.0001); hypercapnia, 1.6% vs. 0.9% (p<0.05); mental status changes, 5.3% vs. 2.7% (p<0.001); accidents, 0.9% vs. 0.3% (p<0.05); and non-compliance, 3.5% vs. 2.3% (p<0.05). Significant differences persisted after adjustment for baseline recipient, donor and transplant factors, and when analyzed separately by donor type.

Conclusion: Although associations may reflect underlying conditions or behaviors, high levels of prescription narcotic use before kidney transplantation predict increased risk of clinical complications after transplantation.

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