We previously identified associations of opioid use before kidney transplant (KTx) with post-KTx complications.

To confirm and extend these findings, we examined a novel database wherein national transplant registry identifiers for KTx recipients were linked to records from a large US pharmaceutical claims warehouse (2008-2015). Pharmacy fills for opioids in the year before KTx were normalized to morphine equivalents (ME). Associations of opioid use with 1-year post-Ktx death and graft failure (adjusted hazard ratio, 95% _LCL aHR 95% _UCL) were quantified by multivariate Cox regression including adjustment for recipient, donor, and transplant factors, and propensity for opioid use. We also assessed opioid use persistence patterns post-KTx and associations with subsequent outcomes.

Among 75,430 eligible patients, 43.1% filled opioids in the year before KTx, and use was more common among recipients who were women, white, unemployed, privately insured, or with longer pre-KTx dialysis. Pre-KTx opioid use bore graded associations with 1-year post-KTx outcomes; highest-level use predicted 45% higher death (aHR 1.281.451.66) and 28% higher all-cause graft loss risk (aHR _1.171.28_1.41). Of recipients with the highest level pre-KTx opioid use, 60% continued high-level use post-KTx (Fig 1B). High-level opioid use in the first year after KTx was associated with twice the risk of death (aHR _1.932.24_2.60) and 68% higher all-cause graft failure risk (aHR _1.501.68_1.89) over the subsequent year (Fig 1B).

While associations may in part reflect underlying conditions or behaviors, opioid use history appears relevant in assessing and providing care to KTx candidates and recipients.

CITATION INFORMATION: Lentine K, Lam N, Segev D, Axelrod D, Zhang Z, Xiao H, Hess G, Kasiske B, Gadi R, Devraj R, Brennan D, Randall H, Schnitzler M. Prescription Opioid Use Before and After Kidney Transplant: Implications for Post-Transplant Outcomes. Am J Transplant. 2017;17 (suppl 3).

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