Opioid use has been associated with significant morbidity and mortality in the United States. Studies within kidney transplantation have also shown increased risk of mortality, graft loss, and complications in kidney transplant recipients who use opioids prior to transplant.
This study was a single-center, retrospective cohort analysis of adult renal transplant recipients between January 2010 and December 2016, assessing the impact of pre-transplant opioid use on post-transplant readmissions at 1 year post-surgery. Opioid use was identified using medication reconciliation or a national prescription database, and readmissions and normalized costs for hospitalizations were identified via the Vizient clinical database.
Pre-transplant opioid exposure occurred in 271 (24%) of 1129 patients transplanted during the study time period. There were no differences in index hospitalization length of stay or cost, however patients with opioid exposure were significantly more likely to have been admitted within 1 year post-surgery (51 vs 43%, p=0.023), had more readmissions per patient (0.93 vs 0.72, p=0.010), and had higher normalized readmissions costs ($12,556 vs $8,344, p=0.009). Patients with opioid exposure were also more likely to be admitted for readmissions, had more admissions per patient, and had higher readmission costs at 30- and 90-days post-surgery. There were no differences in preventability of readmissions between cohorts or in general causes of readmissions. A multivariable logistic regression demonstrated that being opioid experienced and having a history of diabetes were independently associated with readmissions at 1 year post-surgery. Additionally, having opioid exposure at the time of transplant, history of diabetes, and younger age were independently associated with chronic opioid use after transplant.
This study demonstrated that recent exposure to opioids prior to kidney transplant was significantly and independently associated with increased readmissions and readmission costs at multiple timepoints up to 1 year post-transplant, as well as chronic opioid use after transplant. Because opioid use is associated with multiple diseases, it is important to continue to study the association of opioid use, and potential for disease-modifying interactions, with various clinical outcomes.
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