Chronic opioid analgesic usage post-kidney transplantation and clinical outcomes

• Published in: Clinical transplantation Vol. 28; no. 9; pp. 1041 - 1046
• Main Authors: Kulshrestha, Satyarth, Barrantes, Fidel, Samaniego, Milagros, Luan, Fu L.
• Format: Journal Article
• Language: English
• Published: Denmark Blackwell Publishing Ltd 01-09-2014
• Subjects: Adult; Analgesics, Opioid - therapeutic use; Chronic Pain - drug therapy; Chronic Pain - etiology; Female; Follow-Up Studies; Glomerular Filtration Rate; Graft Rejection - drug therapy; Graft Rejection - etiology; Graft Survival; Hospitalization - statistics & numerical data; Humans; Kidney Failure, Chronic - surgery; Kidney Function Tests; kidney transplant; Kidney Transplantation; Male; Middle Aged; opioid; outcomes; pain; Postoperative Complications; Prognosis; Retrospective Studies; Risk Factors; kidney transplant; pain; outcomes; opioid
• ISSN: 0902-0063; 1399-0012
• DOI: 10.1111/ctr.12414

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.