@article{438f6b28196d4646b4c96d4ccb57b2d6,
title = "Outcome implications of benzodiazepine and opioid co-prescription in kidney transplant recipients",
abstract = "The outcomes of benzodiazepine and opioid co-prescription are not well-defined in transplant populations. We examined linked national transplant registry and pharmaceutical records to characterize benzodiazepine and opioid use in the years before and after transplant in large US cohort of kidney transplant recipients (2007-2016; N = 98 620), and associations (adjusted hazard ratio, LCLaHRUCL) with death and graft failure. Among the cohort, 15.6% filled benzodiazepine prescriptions in the year before transplant, and 14.0% filled benzodiazepine prescriptions in the year after transplant (short-acting, 9.5%; long-acting, 3.3%; both 1.1%). Use of short-acting benzodiazepines in the year before transplant was associated with a 22% increased risk of death in the year after transplant (aHR, 1.081.221.38), while use of all classes in the year after transplant was associated with increased risk of death from '1 to 5 years (aHR: short-acting 1.291.391.48; long-acting 1.121.251.40; both 1.461.742.07). Recipients who used benzodiazepines were also more likely to fill opioid prescriptions. Recipients who filled both classes of benzodiazepine and the highest level of opioids had a 2.9-fold increased risk of death compared to recipients who did not use either. Co-prescription of benzodiazepines and opioids in kidney transplant recipients is associated with increased mortality. Ongoing research is needed to understand mechanisms of risk relationships.",
keywords = "benzodiazepines, kidney transplantation, opioids, registries, risk factors",
author = "Lam, {Ngan N.} and Schnitzler, {Mark A.} and Axelrod, {David A.} and Huiling Xiao and Mara McAdams-DeMarco and Segev, {Dorry L.} and Massie, {Allan B.} and Dharnidharka, {Vikas R.} and Naik, {Abhijit S.} and Muzaale, {Abimereki D.} and Hess, {Gregory P.} and Kasiske, {Bertram L.} and Lentine, {Krista L.}",
note = "Funding Information: This work was conducted under the auspices of the Minneapolis Medical Research Foundation (MMRF), contractor for the Scientific Registry of Transplant Recipients (SRTR), as a deliverable under contract no. HHSH250201000018C (US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation). This work was supported by grants from the National Institutes of Health (NIH)/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) R01‐DK120518 and R01‐DK102981. KLL receives support from the Mid‐America Transplant/Jane A. Beckman Endowed Chair in Transplantation. The opinions, results, and conclusions reported in this article are those of the authors and are independent of the funding sources. Funding Information: This work was conducted under the auspices of the Minneapolis Medical Research Foundation (MMRF), contractor for the Scientific Registry of Transplant Recipients (SRTR), as a deliverable under contract no. HHSH250201000018C (US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation). This work was supported by grants from the National Institutes of Health (NIH)/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) R01-DK120518 and R01-DK102981. KLL receives support from the Mid-America Transplant/Jane A. Beckman Endowed Chair in Transplantation. The opinions, results, and conclusions reported in this article are those of the authors and are independent of the funding sources. As a US Government-sponsored work, there are no restrictions on use of this work. The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the US Government. The authors thank SRTR, the NIH colleague Nan Booth, MSW, MPH, and ELS for manuscript editing. Publisher Copyright: {\textcopyright} 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd",
year = "2020",
month = sep,
day = "1",
doi = "10.1111/ctr.14005",
language = "English (US)",
volume = "34",
journal = "Clinical Transplantation",
issn = "0902-0063",
publisher = "Wiley-Blackwell",
number = "9",
}