Predonation Prescription Opioid Use: A Novel Risk Factor for Readmission After Living Kidney Donation

K. L. Lentine, N. N. Lam, M. A. Schnitzler, G. P. Hess, B. L. Kasiske, H. Xiao, D. Axelrod, A. X. Garg, J. D. Schold, H. Randall, N. Dzebisashvili, D. C. Brennan, D. L. Segev

Research output: Contribution to journalArticlepeer-review

12 Scopus citations

Abstract

Implications of opioid use in living kidney donors for key outcomes, including readmission rates after nephrectomy, are unknown. We integrated Scientific Registry of Transplant Recipients data with records from a nationwide pharmacy claims warehouse and administrative records from an academic hospital consortium to quantify predonation prescription opioid use and postdonation readmission events. Associations of predonation opioid use (adjusted odds ratio [aOR]) in the year before donation and other baseline clinical, procedural, and center factors with readmission within 90 days postdonation were examined by using multivariate logistic regression. Among 14 959 living donors, 11.3% filled one or more opioid prescriptions in the year before donation. Donors with the highest level of predonation opioid use (>305 mg/year) were more than twice as likely as nonusers to be readmitted (6.8% vs. 2.6%; aOR 2.49, 95% confidence interval 1.74–3.58). Adjusted readmission risk was also significantly (p < 0.05) higher for women (aOR = 1.25), African Americans (aOR = 1.45), spouses (aOR = 1.42), exchange participants (aOR = 1.46), uninsured donors (aOR = 1.40), donors with predonation estimated glomerular filtration rate <60 mL/min/1.73 m2 (aOR = 2.68), donors with predonation pulmonary conditions (aOR = 1.54), and after robotic nephrectomy (aOR = 1.68). Predonation opioid use is independently associated with readmission after donor nephrectomy. Future research should examine underlying mechanisms and approaches to reducing risks of postdonation complications.

Original languageEnglish (US)
Pages (from-to)744-753
Number of pages10
JournalAmerican Journal of Transplantation
Volume17
Issue number3
DOIs
StatePublished - Mar 1 2017

Bibliographical note

Funding Information:
This work was conducted under the auspices of the Minneapolis Medical Research Foundation (MMRF), contractor for the SRTR, as a deliverable under contract HHSH250201000018C (U.S. Department of Health and Human Services, HRSA, Healthcare Systems Bureau, Division of Transplantation). As a U.S. government?sponsored work, there are no restrictions on its use. The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the U.S. government. This work was supported by grants from the National Institutes of Health (NIH)/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) R01-DK096008 and K24-DK101828. N.N.L. was supported by a KRESCENT New Investigator Award. A.X.G. was supported by the Dr. Adam Linton Chair in Kidney Health Analytics. The opinions, results, and conclusions reported in this article are those of the authors and are independent of the funding sources. The authors thank SRTR colleague Nan Booth, MSW, MPH, ELS, for manuscript editing.

Publisher Copyright:
© Copyright 2016 The American Society of Transplantation and the American Society of Transplant Surgeons

Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.

Keywords

  • donors and donation: living
  • epidemiology
  • health services and outcomes research
  • kidney transplantation/nephrology
  • registry/registry analysis
  • risk assessment/risk stratification

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