Survival implications of opioid use before and after liver transplantation

Henry B. Randall, Tarek Alhamad, Mark A. Schnitzler, Zidong Zhang, Sophia Ford-Glanton, David A. Axelrod, Dorry L. Segev, Bertram L. Kasiske, Gregory P. Hess, Hui Yuan, Rosemary Ouseph, Krista L. Lentine

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60 Scopus citations


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 aHR 95% 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 (aHR and 4 (aHR 1.161.521.98) 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,; level 3, aHR, 1.081.381.77; level 4, aHR, 1.492.012.72). 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.

Original languageEnglish (US)
Pages (from-to)305-314
Number of pages10
JournalLiver Transplantation
Issue number3
StatePublished - Mar 1 2017

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Publisher Copyright:
© 2016 by the American Association for the Study of Liver Diseases.


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