*Purpose: The Centers for Disease Control and Prevention has reported prescription opioid involved deaths increasing since the 1990s. National efforts are being made to fight the opioid epidemic, including prescription drug monitoring programs (PDMPs) that oversee opioid prescribing . Opioids prescribed to kidney transplant recipients at this center post-operatively typically follow a standardized dose (oxycodone/acetaminophen 5/325mg 2 tablets every 6 hours as needed for pain; quantity 24) written at time of discharge irrespective of inpatient use. The purpose of this study is to compare inpatient use of opioids to outpatient prescriptions post-kidney transplant.

*Methods: A single-center, retrospective review of kidney transplant recipients between March and August 2019 was conducted. Fill records reported within the electronic medical record and Georgia PDMP were utilized.

*Results: During the study period, 141 patients were transplanted with a median length of stay of 5.65 days (3-85). Patients remained on patient-controlled analgesia for a median of 1 day (0-3) and required a median of 7 doses (0-75) total of oral opioids. Patient’s pain scale averaged 2.8 (0-9) out of 10 the day prior to discharge resulting in an average of 1.91 oral opioid doses (0-7) administered. Of the prescriptions, 56% followed the standardized dose, 25% did not meet PDMP exception criteria, and 4% did not follow acetaminophen maximum dose recommendations. Following discharge, 16% of patients required an additional opioid prescription [mean 2.4 fills (2-4)], while 23% never filled the prescription given at time of discharge. Comparing patients who required additional refills versus those who never filled their opioid prescription: length of stay was a median of 4 (3-16) and 5 (3-85) days (p=0.1911), total doses of inpatient oral opioids were a median of 9 (2-23) and 4 (0-27) (p=0.0046), oral opioid doses the day of discharge were a mean of 2 (0-5) and 1 (0-4) (p=0.0007), and the average pain score on the day of discharge was 4.3 (0.5-8.33) and 1.8 (0-7.5) (p<0.00001).

*Conclusions: With the expansive range of length of stay, pain scale, and both inpatient and outpatient opioid requirements, personalized opioid prescribing practices may provide a decrease in unnecessary opioid prescriptions following kidney transplantation. If standardized opioid prescribing is continued, reeducation regarding PDMP and acetaminophen dosing should be provided and doses of prescribed opioids may require reduction. Further study is needed to evaluate additional opioid prescriptions if a personalized approach is implemented.

« Back to 2020 American Transplant Congress