title: A history of chronic opioid usage prior to kidney transplantation may be associated with increased mortality risk.
abstract: Chronic opioid usage (COU) for analgesia is common among patients with end-stage renal disease. In order to test whether a prior history of COU negatively affects post-kidney transplant outcomes, we retrospectively examined clinical outcomes in adult kidney transplant patients. Among 1064 adult kidney transplant patients, 452 (42.5%) reported the presence of various body pains and 108 (10.2%) reported a prior history of COU. While the overall death or kidney graft loss was not statistically different between patients with and without a history of COU, the cumulative mortality rate at 1, 3, and 5 years after transplantation, and during the entire study period, appeared significantly higher for patients with than without a history of COU (6.5, 18.5, and 20.4 vs. 3.2, 7.5, and 12.7%, respectively). Multivariate Cox regression analysis adjusted for potential confounding factors in entire cohorts and Cox regression analysis in 1:3 propensity-score matched cohorts suggest that a positive history of COU was significantly associated with nearly a 1.6- to 2-fold increase in the risk of death (hazard ratio 1.65, 95% confidence interval 1.04-2.60, and hazard ratio 1.92, 95% confidence interval 1.08-3.42, respectively). Thus, a history of chronic opioid usage prior to transplantation appears to be associated with increased mortality risk. Additional studies are warranted to confirm the observed association and to understand the mechanisms.
authors.affiliation: Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.
authors.forename: Fidel
authors.initials: F
authors.lastname: Barrantes
authors.forename: Fu L
authors.initials: FL
authors.lastname: Luan
authors.forename: Mallika
authors.initials: M
authors.lastname: Kommareddi
authors.forename: Kareem
authors.initials: K
authors.lastname: Alazem
authors.forename: Tareq
authors.initials: T
authors.lastname: Yaqub
authors.forename: Randy S
authors.initials: RS
authors.lastname: Roth
authors.forename: Randall S
authors.initials: RS
authors.lastname: Sung
authors.forename: Diane M
authors.initials: DM
authors.lastname: Cibrik
authors.forename: Peter
authors.initials: P
authors.lastname: Song
authors.forename: Millie
authors.initials: M
authors.lastname: Samaniego
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D016009:Chi-Square Distribution; D059350:Chronic Pain / Q000188:drug therapy*; D004334:Drug Administration Schedule; D005260:Female; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D057216:Propensity Score; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid