*Purpose: Drug overdose deaths and opioid-involved deaths have reached epidemic levels in the United States. Opioid drugs are currently used to alleviate acute post-operative pain with little to no guidance regarding how much to prescribe. Many people gain access to opioids from a friend or relative without a prescription due to unused medication. Data exists in other general surgery cases quantifying post-operative opioid usage; however, no guidance is given for transplant patients. The purpose of this study will be to quantify the number of opioids kidney transplant patients use post-operatively.

*Methods: All kidney transplant patients received an average prescription of 175 oral morphine milligram equivalents (MME) at discharge. Patients were asked about the number of opioids and non-opioids used at their routine post-operative clinic visits. The quantity of used opioid was verified by pill count and converted to MME. Refill data was verified using the Controlled Substances Reporting System. Patients receiving alemtuzumab induction were discharged on a steroid-free maintenance regimen of calcineurin inhibitor and antimetabolite. Pre-existing chronic pain conditions requiring chronic opioids pre-transplant, patients with a history of opioid abuse, and combined organ transplants were excluded. The research protocol was approved by the hospital institutional review board.

*Results: Thirty-five kidney transplant patients completed the survey. Baseline characteristics and results are shown.

*Conclusions: These data indicate most patients require far fewer opioid pills to control post-operative pain than originally prescribed at discharge (77.5mg used vs. 175mg prescribed). We have implemented an early surgical follow up pathway after kidney transplant that allows us to reduce the quantity of hydrocodone/acetaminophen 5/325 mg prescribed at discharge from 35 tablets (175mg MME) to 20 tablets (100mg MME) while ensuring adequate post op pain control.

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