Pre-Listing Prescription Narcotic Use: Survival Implications in Liver Transplantation.
1Scientific Registry of Transplant Recipients, Minneapolis
2Johns Hopkins, Baltimore
3Dartmouth, Hanover
4East Carolina Univ, Greenville
5Symphony Health, Pittsburgh
6Saint Louis Univ, St. Louis.
Meeting: 2016 American Transplant Congress
Abstract number: 325
Keywords: Liver
Session Information
Date: Monday, June 13, 2016
Session Name: Concurrent Session: Liver Transplantation Peri-Operative Considerations
Session Time: 4:30pm-6:00pm
Presentation Time: 4:30pm-4:42pm
Location: Room 311
Narcotic use among liver transplant (LTX) candidates is common. However, the survival implications and intensity of use are not well understood.
We integrated national SRTR data with pharmacy fill records from a nationwide prescription claims data warehouse for LTX candidates listed between 2008 and 2014. Narcotic fills in the year before listing were normalized to morphine equivalents (ME). Associations of pre-listing narcotic use (adjusted hazard ratio, aHR) and other baseline clinical factors with short-term (1 year) and long-term (2-5 year) patient survival after LTX were assessed with multivariate Cox regression.
Among 41,907 LTX candidates, 48.6% filled ≥1 narcotic prescription in the year before listing, and 25.8% filled multiple prescriptions, equating with a total dose of ≥10 ME/day. Factors associated with pre-listing narcotic use and dose included younger age, white non-Hispanic race/ethnicity, unemployment at listing, and disease due to hepatitis C, drug overdose, or tumors. Of listed patients, 22,114 (52.8%) underwent transplant during the study. We found no association between pre-listing narcotic use or dose and access to transplant, but significant associations with narcotic use and posttransplant survival in multivariate analysis at doses ≥10 ME/day.
LTX Recipient Survival at 1 Year and 2-5 Years Posttransplant by Pre-listing Narcotic Exposure
We also found significant effects on survival for age, sex, race, unemployment, INR, serum creatinine, and primary diagnosis.
Pre-listing narcotic use in more than one-quarter of LTX candidates (≥10 ME/day) is independently associated with increased death risk after LTX. Future work should identify underlying mechanisms and management approaches to improving outcomes.
CITATION INFORMATION: Randall H, Lentine K, Segev D, Yuan H, Tuttle-Newhall J, Nazzal M, Varma C, Hess G, Kasiske B, Schnitzler M. Pre-Listing Prescription Narcotic Use: Survival Implications in Liver Transplantation. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Randall H, Lentine K, Segev D, Yuan H, Tuttle-Newhall J, Nazzal M, Varma C, Hess G, Kasiske B, Schnitzler M. Pre-Listing Prescription Narcotic Use: Survival Implications in Liver Transplantation. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/pre-listing-prescription-narcotic-use-survival-implications-in-liver-transplantation/. Accessed February 27, 2021.« Back to 2016 American Transplant Congress