Opioid use prior to liver transplant is associated with increased risk of death after transplant

Hillary J Braun; Marisa P Schwab; Chengshi Jin; Dominic Amara; Neil J Mehta; Trevor R Grace; Rhiannon Croci; Chris E Freise; John P Roberts; Ryutaro Hirose; Nancy L Ascher

doi:10.1016/j.amjsurg.2020.11.039

Opioid use prior to liver transplant is associated with increased risk of death after transplant

Am J Surg. 2021 Jul;222(1):234-240. doi: 10.1016/j.amjsurg.2020.11.039. Epub 2020 Nov 20.

Authors

Affiliations

¹ Department of Surgery, University of California, San Francisco, San Francisco, CA, USA.
² Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
³ School of Medicine, University of California, San Francisco, San Francisco, CA, USA.
⁴ Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
⁵ Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA.
⁶ Department of Surgery, University of California, San Francisco, San Francisco, CA, USA. Electronic address: nancy.ascher@ucsf.edu.

PMID: 33384155
DOI: 10.1016/j.amjsurg.2020.11.039

Abstract

Background: Opioids are generally discouraged and used sparingly in liver transplant (LT) candidates prior to LT. This study examined the relationship between opioid use at the time of LT and graft and patient survival following transplantation.

Methods: A retrospective single center cohort study of LT recipients from June 2012 to December 2019 was performed. Primary outcomes were graft and patient survival, analyzed with the Kaplan-Meier method and Cox proportional hazards models; primary predictor was active opioid prescription at LT.

Results: 751 LT recipients were included; 16% had an opioid prescription at LT. Post-transplant death was significantly greater in opioid users (pvalue<0.001). In a multivariable Cox model examining predictors of death, opioid use remained associated with a significant increase in the risk of death (HR 2.4 CI 1.5-4.0, p < 0.001) even after controlling for other factors.

Conclusion: Opioid use at LT is associated with a markedly increased risk of death following transplant.

Keywords: Liver; Opioid; Survival; Transplant.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Aged
Analgesics, Opioid / therapeutic use*
Drug Prescriptions / statistics & numerical data
End Stage Liver Disease / complications
End Stage Liver Disease / diagnosis
End Stage Liver Disease / mortality
End Stage Liver Disease / surgery*
Female
Graft Rejection / epidemiology*
Graft Rejection / etiology
Graft Survival
Humans
Kaplan-Meier Estimate
Liver Transplantation / adverse effects*
Liver Transplantation / standards
Male
Middle Aged
Pain / diagnosis
Pain / drug therapy*
Pain / epidemiology
Pain / etiology
Retrospective Studies
Risk Assessment / statistics & numerical data
Risk Factors
Severity of Illness Index
Transplant Recipients / statistics & numerical data
United States / epidemiology

Substances

Analgesics, Opioid

Grants and funding

T32 AI125222/AI/NIAID NIH HHS/United States