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Prescription opioid use before and after heart transplant: Associations with posttransplant outcomes
Author(s) -
Lentine Krista L.,
Shah Kevin S.,
Kobashigawa Jon A.,
Xiao Huiling,
Zhang Zidong,
Axelrod David A.,
Lam Ngan N.,
Segev Dorry L.,
McAdamsDeMarco Mara Ann,
Randall Henry,
Hess Gregory P.,
Yuan Hui,
Vest Luke S.,
Kasiske Bertram L.,
Schnitzler Mark A.
Publication year - 2019
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.15565
Subject(s) - medicine , opioid , intensive care medicine , heart transplantation , medical prescription , heart transplants , transplantation , pharmacology , receptor
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, 95% LCL a HR 95% UCL ) 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 1.10 1.33 1.61 ) 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 1.46 1.70 1.98 ) 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.