Predonation Prescription Opioid Use: A Novel Risk Factor for Readmission After Living Kidney Donation

K. L. Lentine, N. N. Lam, M. A. Schnitzler, G. P. Hess, B. L. Kasiske, H. Xiao, D. Axelrod, A. X. Garg, J. D. Schold, H. Randall, N. Dzebisashvili, D. C. Brennan, D. L. Segev

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)744-753
Number of pages10
JournalAmerican Journal of Transplantation
Volume17
Issue number3
DOIs
StatePublished - Mar 1 2017

Keywords

  • donors and donation: living
  • epidemiology
  • health services and outcomes research
  • kidney transplantation/nephrology
  • registry/registry analysis
  • risk assessment/risk stratification

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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