Recent studies have identified co-prescription of benzodiazepines and opioids as a risk factor for adverse outcomes in the general population. We previously described associations of opioid use before kidney transplantation (KTx) with mortality after KTx, but the implications of benzodiazepine use in the KTx population have not been described.

We examined a novel linkage of SRTR registry data with records from a pharmaceutical claims warehouse (2008-2015) to characterize benzodiazepine and opioid use in the yr before KTx and associations (adjusted hazard ratio, _{95% LCL}aHR_{95% UCL}) with death over 1yr post-KTx.

Among 75,430 KTx recipients with available medication data in the year prior to transplant, 7.3% & 43.1% filled a prescription for a benzodiazepine or opioid in the year prior to transplant. Use of both medications was more common among recipients who were white, unemployed, and previous KTx recipients. Benzodiazepine use rose with higher opioid use, from 3.2% among opioid non-uses to 10.2% among those with the highest level opioid use. (Fig 1).

Compared to non-users, high-level pre-transplant benzodiazepine use was associated with 51% (aHR _1.141.51_1.99) increased risk of death in the year following transplant. Opioid use bore a strong graded relationship with post-KTx survival, and prognostic impact high pre-KTx benzodiazepines was preserved after adjustment for opioids (aHR _1.041.37_1.83), although an interaction was not present (Fig 2).

Benzodiazepines use is correlated with opioiid use before KTx, and use of these agents have additive associations with post-KTx mortality. Future research is needed to define mechanisms of these associations and the impact of reducing co-prescription on improving outcomes after KTx.

CITATION INFORMATION: Lam N., Schnitzler M., Axelrod D., Dharnidharka V., Segev D., Naik A., Xiao H., Ouseph R., Randall H., Hess G., Kasiske B., Brennan D., Alhamad T., Lentine K. Outcome Implications of Benzodiazepines and Opioid Co-Prescriptions before Kidney Transplantation Am J Transplant. 2017;17 (suppl 3).

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