*Purpose: The United States faces an opioid epidemic. Approximately 6% of opioid-naïve surgical patients will develop opioid dependence post-operatively, and the CDC found that patients prescribed more than 50 morphine equivalents (MEQ) per day have twice the risk of opioid overdose compared with patients prescribed less than 20 MEQ/day. These findings inspired the development of opioid prescribing recommendations for common surgical procedures. Living kidney and liver donors represent a unique population of patients who undergo surgery with no medical indication; nearly all donors are discharged with opioid prescriptions, placing them at risk for dependence. This study examined and described opioid requirements in living kidney and liver donors at a single, high volume transplant center.

*Methods: We conducted a retrospective review of all living kidney and liver donors at our institution between 2012-2018 and performed descriptive analyses. MEQ prescribed at discharge were compared with discharge recommendations from comparable surgical procedures; laparoscopic donor nephrectomies were compared with laparoscopic colectomy (150 MEQ), and living donor hepatectomy was compared with open small bowel resection (150 MEQ).

*Results: 623 kidney and 156 liver donors were included. All kidney donors underwent a laparoscopic donor nephrectomy; all liver donors underwent an open donor hepatectomy. Kidney donors were predominantly female (65.7%), with a median age of 42 years, and were related to their recipient (54.7%). 137 patients (22%) had an opioid medication on admission, and 18 (2.9%) had a history of anxiety or depression. Median hospital stay was three days. On the day prior to discharge, donors required a median of 40 MEQ (IQR 22.5-72.5). Donors were discharged with a total of 400 MEQ (IQR 225-400) for 5 days, resulting in a median dose of 60 MEQ/day (IQR 40-80). No patients were discharged on ibuprofen and 125 (20.1%) were discharged on acetaminophen. Liver donors were predominantly female (53.8%), with a median age of 46 years, and were related to their recipient (67.9%). 13 patients (8.3%) were taking an opioid at the time of admission, and 16 (10.2%) had a history of anxiety or depression. Median hospital stay was five days. On the day prior to discharge, patients required a median of 40 MEQ (IQR 20-61.25). Patients were discharged with a median of 375 MEQ (IQR 300-500) for 6.67 days, resulting in a median of 50 MEQ/day (IQR 45-90). Two patients (1.3%) were discharged with ibuprofen, and 56 patients with acetaminophen (35.9%).

*Conclusions: Kidney donors were discharged with 60 MEQ per day, which is greater than the CDC recommendation of 50 MEQ. Compared with similar procedures, both kidney and liver donors received more than twice the amount of recommended MEQ at discharge. Aggressive post-operative multimodal pain regimens and education on opioid prescribing patterns is critical to help decrease the amount of opioids prescribed to this patient population.

« Back to 2019 American Transplant Congress