Assessing Preoperative Opioid Use and Outcomes in Patients With Cystic Fibrosis After Lung Transplantation

Introduction: Pain syndromes are well characterized in people with cystic fibrosis (pwCF). Recent evidence links preoperative opioid use to higher morbidity and worse survival in lung transplantation (LT) recipients, but this is not well studied in pwCF, who may require more opioids than other LT candidates. Methods: We merged the Scientific Registry of Transplant Recipients with pharmacy claims databases and identified pwCF who underwent LT from 2011 to 2021. We defined pre-LT opioid use as filling an opioid prescription within six mo pretransplant. We assessed postoperative complications and survival using multivariable regression adjusted for donor and recipient characteristics. Results: Of the 1,669 LT recipients with cystic fibrosis, 270 (16.2%) had pre-LT opioid use. Recipients with pre-LT opioid use were more likely to be younger, require extracorporeal membrane oxygenation pre-LT, and have donors with a history of smoking. Pre-LT opioid use was associated with higher odds of post-LT opioid use at 0-6 mo (adjusted odds ratio [aOR]: 4.26, P < 0.001), 6-12 mo (aOR: 5.56, P < 0.001), and >12 mo post-LT (aOR: 4.28, P < 0.001). In addition, pre-LT opioid use was associated with higher 5-y mortality risk (adjusted hazards ratio: 1.30, P = 0.027) and was an independent predictor for longer length of hospitalization (point estimate: 0.09, P = 0.02). Conclusions: Pre-LT opioid use in pwCF is associated with higher post-LT opioid use and increased 5-y mortality risk. Future studies are needed to explore the integration of pain management specialists into post-LT care for pwCF to evaluate reduction strategies for post-LT opioid use and the effect on mortality.