Background: Chronic opioid use for pain and opioid substitution therapy (OST) are common among patients with cirrhosis. Little is known of transplant center policies and practices surrounding their use among potential liver transplant candidates.

The purpose of this study was to define national policies and practices surrounding opioid and OST use among potential liver transplant candidates.

Methods: An 8-item survey was developed and electronically administered to active US liver transplant centers. Descriptive statistics were used to understand the current practices and policies.

Results: Fifty-three of 114 (46%) centers responded. Most respondents were hepatologists (60%) or pharmacists (34%). Almost all assessed for opioid use by self-report (96%), toxicology screens (89%), and medical records review (89%); only 42% utilized objective state opioid registry data. While 61% of centers considered chronic opioid use a relative contraindication to transplant, only 38% considered OST to be. Complete discontinuation of opioids and OST was required by 18% and 15%. The majority (55-58%) of centers required co-management and approximately one third required a maximum threshold dose. Only 15% and 9% had a policy regarding opioid or OST use. The majority, 71.7% and 75.5%, of centers did not have a written policy for opioid and OST use. Forty-nine percent of respondents believed that a national consensus policy is needed.Conclusion: Policies and practices surrounding opioid and OST use in liver transplant candidates varied significantly. Our data strongly support the need for a national consensus policy surrounding opioid and OST use in liver transplant candidates.

CITATION INFORMATION: Fleming J, Lai J, Te H, Said A, Spengler E, Rogal S. Opioid and Opioid Substitution Therapy in Liver Transplant Candidates: A Survey of Center Policies and Practices. Am J Transplant. 2017;17 (suppl 3).

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