title: Quantifying prognostic impact of prescription opioid use before kidney transplantation through linked registry and pharmaceutical claims data.
abstract: BACKGROUND
  Limited data are available on the outcome implications of prescription narcotic use before kidney transplantation.
  
  
  METHODS
  We examined a novel database wherein national transplant registry identifiers for kidney transplant recipients were linked to records from a large U.S. pharmaceutical claims clearinghouse (2005-2010). We selected recipients with 1 year of captured pretransplant pharmaceutical fill records (N=31,197). Opioid analgesic fills in the year before transplantation were normalized to morphine equivalents (ME) and expressed as mg/kg exposures. Adjusted associations of ME level with posttransplant graft and patient survival (adjusted hazards ratio, aHR) were quantified by multivariate Cox regression.
  
  
  RESULTS
  Among the 29% of the sample who filled opioid prescriptions in the year before transplantation, the 25th, 50th, and 75th percentiles of annual ME were 1.8, 5.5, and 23.7 mg/kg, respectively. Three-year graft survival was 88.0% and 84.4% in live donor recipients with upper quartiles of ME use, compared with 92.0% among those who did not receive prescription narcotics (P<0.0001). Adjusted risks of posttransplant death and all-cause graft loss in live donor recipients with the highest quartile of narcotic use were 2.3 times (aHR, 2.27; 95% confidence interval, 1.66-3.10) and 1.8 times (aHR, 1.75; 95% confidence interval, 1.37-2.26), respectively, that of narcotic nonusers. Graded associations of pretransplant opioid exposure level with death and graft loss after deceased donor transplantation were also observed.
  
  
  CONCLUSIONS
  Although associations may in part reflect underlying conditions or behaviors, high levels of prescription opioid use before kidney transplantation predict increased risk of posttransplant death and graft loss.
authors.affiliation: 1 Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO. 2 Division of Abdominal Transplantation, Department of Surgery, Saint Louis University School of Medicine, St. Louis, MO. 3 Department of Anesthesia, Saint Louis University School of Medicine, St. Louis, MO. 4 Division of Abdominal Transplantation, Department of Surgery, Dartmouth Hitchcock Medical Center, Hanover, NH. 5 Transplant Nephrology, Washington University School of Medicine, St. Louis, MO.
authors.forename: Krista L
authors.initials: KL
authors.lastname: Lentine
authors.forename: Hui
authors.initials: H
authors.lastname: Yuan
authors.forename: Janet E
authors.initials: JE
authors.lastname: Tuttle-Newhall
authors.forename: Huiling
authors.initials: H
authors.lastname: Xiao
authors.forename: Vikram
authors.initials: V
authors.lastname: Chawa
authors.forename: David
authors.initials: D
authors.lastname: Axelrod
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Brennan
authors.forename: Vikas R
authors.initials: VR
authors.lastname: Dharnidharka
authors.forename: Christopher
authors.initials: C
authors.lastname: Beuer
authors.forename: Mark A
authors.initials: MA
authors.lastname: Schnitzler
mesh_terms: D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D057225:Data Mining; D011307:Drug Prescriptions; D017723:Drug Utilization Review; D005260:Female; D006085:Graft Survival; D006801:Humans; D007356:Insurance, Pharmaceutical Services; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000628:therapy*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D057216:Propensity Score; D016016:Proportional Hazards Models; D012042:Registries; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid