title: Survival implications of opioid use before and after liver transplantation.
abstract: Implications of prescription opioid use for outcomes after liver transplantation (LT) have not been described. We integrated national transplant registry data with records from a large pharmaceutical claims clearinghouse (2008-2014; n = 29,673). Opioid fills on the waiting list were normalized to morphine equivalents (MEs), and exposure was categorized as follows: > 0-2 ME/day (level 1), > 2-10 ME/day (level 2), > 10-70 ME/day (level 3), and >70 ME/day (level 4). Associations (adjusted hazard ratio [aHR],95% LCLaHR95% UCL) of pretransplant ME level with patient and graft survival over 5 years after transplant were quantified by multivariate Cox regression including adjustment for recipient, donor, and transplant factors, as well as propensity adjustment for opioid use. Overall, 9.3% of recipients filled opioids on the waiting list. Compared with no use, level 3 (aHR1.061.281.55) and 4 (aHR1.161.521.98) opioid use during listing were associated with increased mortality over 5 years after transplant. These associations were driven by risk after the first transplant anniversary, such that mortality >1-5 years increased in a graded manner with higher use on the waiting list (level 2, aHR,1.001.271.62; level 3, aHR,1.081.381.77; level 4, aHR,1.492.012.72). Similar patterns occurred for graft failure. Of recipients with the highest level of opioids on the waiting list, 65% had level 3 or 4 use in the first year after transplant, including 55% with use at these levels from day 90-365 after transplant. Opioid use in the first year after transplant also bore graded associations with subsequent death and graft loss >1-5 years after transplant. Opioid use history may be relevant in assessing and providing care to LT candidates. Liver Transplantation 23 305-314 2017 AASLD.
authors.affiliation: Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO.
authors.forename: Henry B
authors.initials: HB
authors.lastname: Randall
authors.affiliation: Transplant Nephrology, Washington University School of Medicine, St. Louis, MO.
authors.forename: Tarek
authors.initials: T
authors.lastname: Alhamad
authors.affiliation: Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Schnitzler
authors.affiliation: Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO.
authors.forename: Zidong
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Department of Surgery, Saint Louis University School of Medicine, St. Louis, MO.
authors.forename: Sophia
authors.initials: S
authors.lastname: Ford-Glanton
authors.affiliation: Division of Abdominal Transplantation, Department of Surgery, Brody School of Medicine, Greenville, NC.
authors.forename: David A
authors.initials: DA
authors.lastname: Axelrod
authors.affiliation: Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Dorry L
authors.initials: DL
authors.lastname: Segev
authors.affiliation: Division of Nephrology, Hennepin County Medical Center, Minneapolis, MN.
authors.forename: Bertram L
authors.initials: BL
authors.lastname: Kasiske
authors.affiliation: Symphony Health, Pittsburgh, PA.|Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA.
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Hess
authors.affiliation: Department of Anesthesia, Saint Louis University School of Medicine, St. Louis, MO.
authors.forename: Hui
authors.initials: H
authors.lastname: Yuan
authors.affiliation: Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO.
authors.forename: Rosemary
authors.initials: R
authors.lastname: Ouseph
authors.affiliation: Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO.
authors.forename: Krista L
authors.initials: KL
authors.lastname: Lentine
mesh_terms: D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D058625:End Stage Liver Disease / Q000150:complications / Q000401:mortality* / Q000601:surgery; D005260:Female; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D018579:Patient Selection; D055553:Prescription Drugs / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D057216:Propensity Score; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D014850:Waiting Lists / Q000401:mortality; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D055553:Prescription Drugs