title: Chronic opioid analgesic usage post-kidney transplantation and clinical outcomes.
abstract: Chronic opioid usage (COU) is common among patients with end-stage renal disease (ESRD) qualified for kidney transplantation and associated with inferior post-transplant outcomes. The magnitude of COU after kidney transplantation and its impact on transplant outcomes remain unknown. We performed a single-center retrospective study aimed to describe the prevalence of COU during the first year, to identify the predictors of COU and to determine the impact of COU on post-transplant outcomes including the rates of hospitalization and acute rejection during the first year, as well as long-term patient and graft survival. Among 1045 kidney transplant patients, 119 (11.4%) had required continued outpatient prescription of opioid analgesics during the first year after kidney transplantation, mostly for non-surgery-related pain (85%). A positive history of COU prior to transplantation was the strongest predictor of COU in the first year post-transplantation (adjusted odds ratio [AOR] 4.31, p < 0.001). Patients with COU had more often hospital admission during the first year (AOR 2.48, p = 0.001, for 1 or 2 admissions, and AOR 6.03, p < 0.001 for ≥3 admissions), but similar rate of acute rejection (19.3% vs. 15.7%, p = 0.31). During long-term follow-up, however, the patient and/or death-censored kidney survival was not different. COU early post-kidney transplantation, when clinically indicated and properly supervised, does not appear to affect the risk of death and death-censored graft failure.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Satyarth
authors.initials: S
authors.lastname: Kulshrestha
authors.forename: Fidel
authors.initials: F
authors.lastname: Barrantes
authors.forename: Milagros
authors.initials: M
authors.lastname: Samaniego
authors.forename: Fu L
authors.initials: FL
authors.lastname: Luan
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D059350:Chronic Pain / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000188:drug therapy* / Q000209:etiology; D006085:Graft Survival; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000701:Analgesics, Opioid
keywords: kidney transplant; opioid; outcomes; pain