title: Predonation Prescription Opioid Use: A Novel Risk Factor for Readmission After Living Kidney Donation.
abstract: Implications of opioid use in living kidney donors for key outcomes, including readmission rates after nephrectomy, are unknown. We integrated Scientific Registry of Transplant Recipients data with records from a nationwide pharmacy claims warehouse and administrative records from an academic hospital consortium to quantify predonation prescription opioid use and postdonation readmission events. Associations of predonation opioid use (adjusted odds ratio [aOR]) in the year before donation and other baseline clinical, procedural, and center factors with readmission within 90 days postdonation were examined by using multivariate logistic regression. Among 14 959 living donors, 11.3% filled one or more opioid prescriptions in the year before donation. Donors with the highest level of predonation opioid use (>305 mg/year) were more than twice as likely as nonusers to be readmitted (6.8% vs. 2.6%; aOR 2.49, 95% confidence interval 1.74-3.58). Adjusted readmission risk was also significantly (p < 0.05) higher for women (aOR = 1.25), African Americans (aOR = 1.45), spouses (aOR = 1.42), exchange participants (aOR = 1.46), uninsured donors (aOR = 1.40), donors with predonation estimated glomerular filtration rate <60 mL/min/1.73 m2(aOR = 2.68), donors with predonation pulmonary conditions (aOR = 1.54), and after robotic nephrectomy (aOR = 1.68). Predonation opioid use is independently associated with readmission after donor nephrectomy. Future research should examine underlying mechanisms and approaches to reducing risks of postdonation complications.
authors: Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO.
authors: K L
authors: KL
authors: Lentine
authors: Division of Nephrology, University of Alberta, Edmonton, AB, Canada.
authors: N N
authors: NN
authors: Lam
authors: Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO.
authors: M A
authors: MA
authors: Schnitzler
authors: Symphony Health, Pittsburgh, PA.|Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA.
authors: G P
authors: GP
authors: Hess
authors: Division of Nephrology, Hennepin County Medical Center, Minneapolis, MN.
authors: B L
authors: BL
authors: Kasiske
authors: Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO.
authors: H
authors: H
authors: Xiao
authors: Division of Abdominal Transplantation, Department of Surgery, Brody School of Medicine, Greenville, NC.
authors: D
authors: D
authors: Axelrod
authors: Division of Nephrology, Western University, London, ON, Canada.
authors: A X
authors: AX
authors: Garg
authors: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH.
authors: J D
authors: JD
authors: Schold
authors: Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO.
authors: H
authors: H
authors: Randall
authors: Dickson Advanced Analytics, Carolinas HealthCare System, Charlotte, NC.
authors: N
authors: N
authors: Dzebisashvili
authors: Transplant Nephrology, Washington University School of Medicine, St. Louis, MO.
authors: D C
authors: DC
authors: Brennan
authors: Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD.
authors: D L
authors: DL
authors: Segev
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D009392:Nephrectomy; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011379:Prognosis; D012042:Registries; D012307:Risk Factors; D020858:Tissue and Organ Harvesting / Q000379:methods*
chemical_list: D000701:Analgesics, Opioid
keywords: donors and donation: living; epidemiology; health services and outcomes research; kidney transplantation/nephrology; registry/registry analysis; risk assessment/risk stratification