Prescription opioid use before and after kidney transplant: Implications for posttransplant outcomes

Evolving literature suggests that the epidemic of prescription opioid use affects the transplant population. We examined a novel database wherein national U.S. transplant registry records were linked to a large pharmaceutical claims warehouse (2007-2015) to characterize prescription opioid use before and after kidney transplant, and associations (adjusted hazard ratio, _{95% LCL}aHR_{95% UCL}) with death and graft loss. Among 75 430 eligible patients, 43.1% filled opioids in the year before transplant. Use was more common among recipients who were women, white, unemployed, publicly insured, and with longer pretransplant dialysis. Of those with the highest level of pretransplant opioid use, 60% continued high-level use posttransplant. Pretransplant opioid use had graded associations with one-year posttransplant outcomes; the highest-level use predicted 46% increased risk of death (aHR _1.281.46_1.66) and 28% increased risk of all-cause graft failure (aHR _1.171.28_1.41). Effects of high-level opioid use in the first year after transplant were stronger, predicting twice the risk of death (aHR _1.932.24_2.60) and 68% higher all-cause graft failure risk (aHR _1.501.68_1.89) over the subsequent year; increased risk persisted over five years. 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.