K.L. Lentine, N.N. Lam, A.S. Naik, D.A. Axelrod, Z. Zhang, V.R. Dharnidharka, G.P. Hess, D.L. Segev, R. Ouseph, H. Randall, T. Alhamad, R. Devraj, R. Gadi, B.L. Kasiske, D.C. Brennan, M.A. Schnitzler

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 to 2015) to characterize prescription opioid use before and after kidney transplant, and associations (adjusted hazard ratio,95%LCLaHR95%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 pre-transplant dialysis. Of those with the highest level of pre-transplant opioid use, 60% continued high-level use post-transplant. Pre-transplant opioid use had graded associations with 1-year post-transplant outcomes; the highest-level use predicted 46% increased risk of death (aHR1.281.461.66) and 28% increased risk of all-cause graft failure (aHR1.171.281.41). Effects of high-level opioid use in the first year after transplant were stronger, predicting twice the risk of death (aHR1.932.242.60) and 68% higher all-cause graft loss risk (aHR1.501.681.89) over the subsequent year; increased risk persisted over 5 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. This article is protected by copyright. All rights reserved.