*Purpose: Opioid use following kidney transplant (KTX) is associated with higher graft and patient loss. Thus, in 2019 we implemented an opioid minimization quality improvement (QI) endeavor using multi-modal strategies.

*Methods: This was a single-center, retrospective QI project that assessed peri-operative opioid use following the implementation of an opioid sparing protocol (preoperative TAP/QL block, scheduled APAP and gabapentin). Opioid use was collected by querying the statewide prescription drug monitoring program (PDMP) and is reported in mean morphine equivalents (MME), comparing KTX patients that occurred before vs. after implementation of the opioid QI protocol; opioids used during the pre- vs. 30-day post-operative period was collected and compared.

*Results: A total of 743 patients were included, with 245 patients in the pre-protocol group vs. 498 in the opioid-sparing group. In-hospital MME per day in the pre-intervention group was 20.2 mg/day compared to 15 mg/day in the peri-operative group (p<0.001; Table 1). In the pre-intervention group 96.3% of patients were discharged with an opioid prescription compared to 6.8% in the post-intervention group (p<0.001). KTX recipients that had received an intraoperative nerve block had a 60% reduction in discharge opioid prescriptions.

*Conclusions: Results of this large-scale QI endeavor demonstrate significant and sustained reductions of in-hospital and 30-day opioid use after implementation a multimodal pain management protocol.

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