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

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

Publication date: Dec 01, 2019

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, aHR ) 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 1.33 ) 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 1.70 ) 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.

Lentine, K.L., Shah, K.S., Kobashigawa, J.A., Xiao, H., Zhang, Z., Axelrod, D.A., Lam, N.N., Segev, D.L., McAdams-DeMarco, M.A., Randall, H., Hess, G.P., Yuan, H., Vest, L.S., Kasiske, B.L., and Schnitzler, M.A. Prescription opioid use before and after heart transplant: Associations with posttransplant outcomes. 04291. 2019 Am J Transplant (19):12.

Concepts Keywords
Graft Anesthesia pain management
Heart Transplant Pain management
Heart Transplantation Heart transplant
Morphine Medical specialties
Mortality Medicine
Opioid Clinical medicine
Opioid Epidemic Organ transplantation
Opioids Opioid epidemic
Pharmaceutical Heart transplantation
RTT
Ketones
Transplantation

Semantics

Type Source Name
disease MESH death
drug DRUGBANK Morphine
disease MESH risk factors

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