*Purpose: Opioid use following kidney transplantation (KTX) is associated with an increased risk of graft loss and mortality. Opioid minimization strategies and protocols have demonstrated reductions in short term opioid use after KTX. This large-scale quality improvement (QI) project sought to evaluate the long-term impact of opioid minimization in KTX.

*Methods: This was a single-center QI endeavor in KTX recipients to assess the post-operative opioid use following the implementation of an opioid sparing protocol (preoperative TAP/QL block, scheduled APAP and gabapentin). All opioid use was gathered by querying the statewide prescription drug monitoring program (PDMP) and is reported in MME, comparing KTX patients in the pre- vs. post-QI time periods and gathering data to one-year post-transplant.

*Results: A total of 743 patients were included, with 245 patients in the pre-protocol group vs. 498 in the post-protocol group. The total MME in the 1-year follow up period in the pre group was 1,203.7 compared to 581.9 in the post-intervention, multimodal pain protocol group (Figure 1). 313 patients (62.9%) in the post-intervention group had no MME in the follow up period compared with 7 patients (2.9%) in the pre-intervention group (OR 57.52; Cl 26.55-124.65). Patients in the post-protocol group had 99% lower odds of filling more than 100 MME in the 1-year follow up period (adjusted OR 0.01; CI 0.01 to 0.03, p<0.001). Most importantly, opioid naive KTX patients receiving the multimodal opioid minimization strategy were half as likely to become chronic opioid users (COUs), as compared to KTX occurring in the pre-protocol time period (OR 0.44, 95% CI 0.20 to 0.98; p=0.04, see Figure 2), while pre-KTX COUs were significantly more likely to become opioid naive following implementation of this protocol.

*Conclusions: Results of this long-term, large-scale QI project demonstrate a significant reduction in long-term opioid use after KTX following the implementation of a multimodal opioid sparing pain protocol.

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