title: Associations of pre-transplant prescription narcotic use with clinical complications after kidney transplantation.
abstract: BACKGROUND
  The impact of narcotic use before kidney transplantation on post-transplant clinical outcomes is not well described.
  
  
  METHODS
  We examined integrated national transplant registry, pharmacy records, and Medicare billing claims to follow 16,322 kidney transplant recipients, of whom 28.3% filled a narcotic prescription in the year before transplantation. Opioid analgesic fills were normalized to morphine equivalents (ME) and expressed as mg/kg exposures (approximate quartiles: 0.1-1.7, 1.8-5.4, 5.5-23.7, and ≥ 23.8 mg/kg, respectively). Post-transplant cardiovascular, respiratory, neurological, accidents, substance abuse, and noncompliance events were identified using diagnosis codes on Medicare billing claims. Adjusted associations of ME level with post-transplant complications were quantified by multivariate Cox regression.
  
  
  RESULTS
  The incidence of complications at 3 years post-transplant among those with the highest pre-transplant ME exposure compared to no use included: ventricular arrhythmias, 1.1 vs. 0.2% (p < 0.001); cardiac arrest, 4.7 vs. 2.7% (p < 0.05); hypotension, 14 vs. 8% (p < 0.0001); hypercapnia, 1.6 vs. 0.9% (p < 0.05); mental status changes, 5.3 vs. 2.7% (p < 0.001); drug abuse/dependence, 7.0 vs. 1.7% (p < 0.0001); alcohol abuse, 1.8 vs. 0.6% (p = 0.0001); accidents, 0.9 vs. 0.3% (p < 0.05); and noncompliance, 3.5 vs. 2.3% (p < 0.05). In multivariate analyses, transplant recipients with the highest level of pre-transplant narcotic use had approximately 2 to 4 times the risks of post-transplant ventricular arrhythmias, mental status changes, drug abuse, alcohol abuse, and accidents compared with non-users, and 35-45% higher risks of cardiac arrest and hypotension.
  
  
  CONCLUSIONS
  Although associations may reflect underlying conditions or behaviors, high-level prescription narcotic use before kidney transplantation predicts increased risk of clinical complications after transplantation.
authors.affiliation: Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, Mo., USA.
authors.forename: Krista L
authors.initials: KL
authors.lastname: Lentine
authors.forename: Ngan N
authors.initials: NN
authors.lastname: Lam
authors.forename: Huiling
authors.initials: H
authors.lastname: Xiao
authors.forename: Janet E
authors.initials: JE
authors.lastname: Tuttle-Newhall
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: Hui
authors.initials: H
authors.lastname: Yuan
authors.forename: Mustafa
authors.initials: M
authors.lastname: Nazzal
authors.forename: Jie
authors.initials: J
authors.lastname: Zheng
authors.forename: Mark A
authors.initials: MA
authors.lastname: Schnitzler
mesh_terms: D000059:Accidents / Q000706:statistics & numerical data; D000067575:Administrative Claims, Healthcare; D000293:Adolescent; D000328:Adult; D000437:Alcoholism / Q000453:epidemiology; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D001145:Arrhythmias, Cardiac / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology; D006801:Humans; D006935:Hypercapnia / Q000453:epidemiology; D007022:Hypotension / Q000453:epidemiology; D015994:Incidence; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D019520:Living Donors; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D057234:Preoperative Period; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid
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