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Outcome implications of benzodiazepine and opioid co‐prescription in kidney transplant recipients
Author(s) -
Lam Ngan N.,
Schnitzler Mark A.,
Axelrod David A.,
Xiao Huiling,
McAdamsDeMarco Mara,
Segev Dorry L.,
Massie Allan B.,
Dharnidharka Vikas R.,
Naik Abhijit S.,
Muzaale Abimereki D.,
Hess Gregory P.,
Kasiske Bertram L.,
Lentine Krista L.
Publication year - 2020
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.14005
Subject(s) - medicine , benzodiazepine , medical prescription , opioid , cohort , hazard ratio , kidney transplantation , cohort study , kidney transplant , pharmacoepidemiology , transplantation , pharmacology , confidence interval , receptor
Abstract The outcomes of benzodiazepine and opioid co‐prescription are not well‐defined in transplant populations. We examined linked national transplant registry and pharmaceutical records to characterize benzodiazepine and opioid use in the years before and after transplant in large US cohort of kidney transplant recipients (2007‐2016; N = 98 620), and associations (adjusted hazard ratio, LCL aHR UCL ) with death and graft failure. Among the cohort, 15.6% filled benzodiazepine prescriptions in the year before transplant, and 14.0% filled benzodiazepine prescriptions in the year after transplant (short‐acting, 9.5%; long‐acting, 3.3%; both 1.1%). Use of short‐acting benzodiazepines in the year before transplant was associated with a 22% increased risk of death in the year after transplant (aHR, 1.08 1.22 1.38 ), while use of all classes in the year after transplant was associated with increased risk of death from >1 to 5 years (aHR: short‐acting 1.29 1.39 1.48 ; long‐acting 1.12 1.25 1.40 ; both 1.46 1.74 2.07 ). Recipients who used benzodiazepines were also more likely to fill opioid prescriptions. Recipients who filled both classes of benzodiazepine and the highest level of opioids had a 2.9‐fold increased risk of death compared to recipients who did not use either. Co‐prescription of benzodiazepines and opioids in kidney transplant recipients is associated with increased mortality. Ongoing research is needed to understand mechanisms of risk relationships.