*Purpose: The opioid epidemic in the United States (US) and the known risks of opioid utilization highlight the need for better understanding of pain management around kidney transplantation. Although studies have been published describing efforts to minimize opioid therapy, clinical practices across the US remain unknown. The purpose of this survey study was to describe the utilization of opioids in the perioperative timeframe and upon discharge after kidney transplantation in the US.

*Methods: This study was a cross-sectional survey of transplant pharmacists to evaluate the national landscape of opioid management with regards to pre-transplant candidacy, perioperative pain management, and post-transplant pain management. A 25-question survey was distributed to members of transplant pharmacy listservs within the US in March 2020.

*Results: A total of 63/208 (30.3%) adult kidney transplant centers responded to the survey. Table 1 details survey demographics. The majority of institutions (84%) utilized opioids for first-line post-operative pain management in opioid-naïve patients. More than half of the centers (55%) did not differentiate post-operative pain regimen between opioid-naïve and opioid-tolerant patients. A total of 72.6% of institutions prescribed opioids upon discharge from transplant, and 10.8% of the institutions prescribed subsequent opioid analgesics in the outpatient setting. Figure 1 and Table 2 summarizes opioid utilization. Many patients were actively listed while on opioids (84.1%) or medications for opioid use disorder medications (MOUD) (58.2%) (Table 3). Many responders (82.7%) reported their institutions did not have a written protocol or policy for post-transplant pain management.

*Conclusions: This survey highlights the existence of significant practice heterogeneity regarding opioid and MOUD utilization across kidney transplant programs in the US. Our survey highlights the opportunity transplant pharmacists have within the context of their multidisciplinary team to develop multimodal pain management strategies to minimize opioid use in kidney transplant candidates and recipients to continue to optimize patient care.

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