Prescription opioid use before and after heart transplant: Associations with posttransplant outcomes

Krista L. Lentine, Kevin S. Shah, Jon A. Kobashigawa, Huiling Xiao, Zidong Zhang, David A. Axelrod, Ngan N. Lam, Dorry L. Segev, Mara Ann McAdams-DeMarco, Henry Randall, Gregory P. Hess, Hui Yuan, Luke S. Vest, Bertram L. Kasiske, Mark A. Schnitzler

Research output: Contribution to journalArticle

Abstract

Impacts of the prescription opioid epidemic have not yet been examined in the context of heart transplantation. We examined a novel database in which national U.S. transplant registry records were linked to a large pharmaceutical claims warehouse (2007-2016) to characterize prescription opioid use before and after heart transplant, and associations (adjusted hazard ratio, 95% LCLaHR95% UCL) with death and graft loss. Among 13 958 eligible patients, 40% filled opioids in the year before transplant. Use was more common among recipients who were female, white, or unemployed, or who underwent transplant in more recent years. Of those with the highest level of pretransplant opioid use, 71% continued opioid use posttransplant. Pretransplant use had graded associations with 1-year posttransplant outcomes; compared with no use, the highest-level use (>1000 mg morphine equivalents) predicted 33% increased risk of death (aHR 1.101.331.61) in the year after transplant. Risk relationships with opioid use in the first year posttransplant were stronger, with highest level use predicting 70% higher mortality (aHR 1.461.701.98) over the subsequent 4 years (from >1 to 5 years posttransplant). While associations may, in part, reflect underlying conditions or behaviors, opioid use history is relevant in assessing and providing care to transplant candidates and recipients.

Original languageEnglish (US)
JournalAmerican Journal of Transplantation
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Opioid Analgesics
Prescriptions
Transplants
Heart Transplantation
Morphine
Registries
History
Databases
Mortality
Pharmaceutical Preparations

Keywords

  • anesthesia/pain management
  • clinical research/practice
  • epidemiology
  • health services and outcomes research
  • heart transplantation
  • heart transplantation/cardiology
  • opioids
  • registries
  • risk assessment/risk stratification
  • risk factors
  • Scientific Registry for Transplant Recipients (SRTR)

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

Cite this

Lentine, K. L., Shah, K. S., Kobashigawa, J. A., Xiao, H., Zhang, Z., Axelrod, D. A., ... Schnitzler, M. A. (Accepted/In press). Prescription opioid use before and after heart transplant: Associations with posttransplant outcomes. American Journal of Transplantation. https://doi.org/10.1111/ajt.15565

Prescription opioid use before and after heart transplant : Associations with posttransplant outcomes. / Lentine, Krista L.; Shah, Kevin S.; Kobashigawa, Jon A.; Xiao, Huiling; Zhang, Zidong; Axelrod, David A.; Lam, Ngan N.; Segev, Dorry L.; McAdams-DeMarco, Mara Ann; Randall, Henry; Hess, Gregory P.; Yuan, Hui; Vest, Luke S.; Kasiske, Bertram L.; Schnitzler, Mark A.

In: American Journal of Transplantation, 01.01.2019.

Research output: Contribution to journalArticle

Lentine, KL, Shah, KS, Kobashigawa, JA, Xiao, H, Zhang, Z, Axelrod, DA, Lam, NN, Segev, DL, McAdams-DeMarco, MA, Randall, H, Hess, GP, Yuan, H, Vest, LS, Kasiske, BL & Schnitzler, MA 2019, 'Prescription opioid use before and after heart transplant: Associations with posttransplant outcomes', American Journal of Transplantation. https://doi.org/10.1111/ajt.15565
Lentine, Krista L. ; Shah, Kevin S. ; Kobashigawa, Jon A. ; Xiao, Huiling ; Zhang, Zidong ; Axelrod, David A. ; Lam, Ngan N. ; Segev, Dorry L. ; McAdams-DeMarco, Mara Ann ; Randall, Henry ; Hess, Gregory P. ; Yuan, Hui ; Vest, Luke S. ; Kasiske, Bertram L. ; Schnitzler, Mark A. / Prescription opioid use before and after heart transplant : Associations with posttransplant outcomes. In: American Journal of Transplantation. 2019.
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abstract = "Impacts of the prescription opioid epidemic have not yet been examined in the context of heart transplantation. We examined a novel database in which national U.S. transplant registry records were linked to a large pharmaceutical claims warehouse (2007-2016) to characterize prescription opioid use before and after heart transplant, and associations (adjusted hazard ratio, 95{\%} LCLaHR95{\%} UCL) with death and graft loss. Among 13 958 eligible patients, 40{\%} filled opioids in the year before transplant. Use was more common among recipients who were female, white, or unemployed, or who underwent transplant in more recent years. Of those with the highest level of pretransplant opioid use, 71{\%} continued opioid use posttransplant. Pretransplant use had graded associations with 1-year posttransplant outcomes; compared with no use, the highest-level use (>1000 mg morphine equivalents) predicted 33{\%} increased risk of death (aHR 1.101.331.61) in the year after transplant. Risk relationships with opioid use in the first year posttransplant were stronger, with highest level use predicting 70{\%} higher mortality (aHR 1.461.701.98) over the subsequent 4 years (from >1 to 5 years posttransplant). While associations may, in part, reflect underlying conditions or behaviors, opioid use history is relevant in assessing and providing care to transplant candidates and recipients.",
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