Survival implications of opioid use before and after liver transplantation. Issue 3 (March 2017)

• Record Type: Journal Article
• Authors: Randall, Henry B.; Alhamad, Tarek; Schnitzler, Mark A.; Zhang, Zidong; Ford‐Glanton, Sophia; Axelrod, David A.; Segev, Dorry L.; Kasiske, Bertram L.; Hess, Gregory P.; Yuan, Hui; Ouseph, Rosemary; Lentine, Krista L.
• Is Part Of: Liver transplantation. Volume 23:Issue 3(2017:Mar.)
• Page Start: 305
• Page End: 314
• Publication Date: 2017-03
• Subjects: Liver -- Transplantation -- Periodicals; Liver -- Diseases -- Periodicals; Liver Transplantation -- Periodicals; Foie -- Greffe -- Périodiques; 617.5560592
• DOI: 10.1002/lt.24714
• Languages: English
• ISSNs: 1527-6465

Abstract

Abstract : Implications of prescription opioid use for outcomes after liver transplantation (LT) have not been described. We integrated national transplant registry data with records from a large pharmaceutical claims clearinghouse (2008‐2014; n = 29, 673). Opioid fills on the waiting list were normalized to morphine equivalents (MEs), and exposure was categorized as follows: > 0‐2 ME/day (level 1), > 2‐10 ME/day (level 2), > 10‐70 ME/day (level 3), and >70 ME/day (level 4). Associations (adjusted hazard ratio [aHR], 95% LCL aHR95% UCL ) of pretransplant ME level with patient and graft survival over 5 years after transplant were quantified by multivariate Cox regression including adjustment for recipient, donor, and transplant factors, as well as propensity adjustment for opioid use. Overall, 9.3% of recipients filled opioids on the waiting list. Compared with no use, level 3 (aHR1.06 1.281.55 ) and 4 (aHR1.16 1.521.98 ) opioid use during listing were associated with increased mortality over 5 years after transplant. These associations were driven by risk after the first transplant anniversary, such that mortality >1‐5 years increased in a graded manner with higher use on the waiting list (level 2, aHR, 1.00 1.271.62 ; level 3, aHR, 1.08 1.381.77 ; level 4, aHR, 1.49 2.012.72 ). Similar patterns occurred for graft failure. Of recipients with the highest level of opioids on the waiting list, 65% had level 3 or 4 use in the first year after transplant, including 55% with use at these levels from day 90‐365 after transplant. Opioid use in the first year after transplant also bore graded associations with subsequent death and graft loss >1‐5 years after transplant. Opioid use history may be relevant in assessing and providing care to LT candidates. Liver Transplantation 23 305–314 2017 AASLD .