Prescription opioid use before and after heart transplant: Associations with posttransplant outcomes

Krista L. Lentine; Kevin S. Shah; Jon A. Kobashigawa; Huiling Xiao; Zidong Zhang; David A. Axelrod; Ngan N. Lam; Dorry L. Segev; Mara Ann McAdams-DeMarco; Henry Randall; Gregory P. Hess; Hui Yuan; Luke S. Vest; Bertram L. Kasiske; Mark A. Schnitzler

doi:10.1111/ajt.15565

Prescription opioid use before and after heart transplant: Associations with posttransplant outcomes

Krista L. Lentine, Kevin S. Shah, Jon A. Kobashigawa, Huiling Xiao, Zidong Zhang, David A. Axelrod, Ngan N. Lam, Dorry L. Segev, Mara Ann McAdams-DeMarco, Henry Randall, Gregory P. Hess, Hui Yuan, Luke S. Vest, Bertram L. Kasiske, Mark A. Schnitzler

School of Medicine

Research output: Contribution to journal › Article › peer-review

5 Scopus citations

Abstract

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% _LCLaHR_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 _1.101.33_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 _1.461.70_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.

Original language	English (US)
Pages (from-to)	3405-3414
Number of pages	10
Journal	American Journal of Transplantation
Volume	19
Issue number	12
DOIs	https://doi.org/10.1111/ajt.15565
State	Published - Dec 1 2019

Keywords

Scientific Registry for Transplant Recipients (SRTR)
anesthesia/pain management
clinical research/practice
epidemiology
health services and outcomes research
heart transplantation
heart transplantation/cardiology
opioids
registries
risk assessment/risk stratification
risk factors

ASJC Scopus subject areas

Immunology and Allergy
Transplantation
Pharmacology (medical)

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10.1111/ajt.15565

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Lentine, K. L., Shah, K. S., Kobashigawa, J. A., Xiao, H., Zhang, Z., Axelrod, D. A., Lam, N. N., Segev, D. L., McAdams-DeMarco, M. A., Randall, H., Hess, G. P., Yuan, H., Vest, L. S., Kasiske, B. L., & Schnitzler, M. A. (2019). Prescription opioid use before and after heart transplant: Associations with posttransplant outcomes. American Journal of Transplantation, 19(12), 3405-3414. https://doi.org/10.1111/ajt.15565

Lentine, KL, Shah, KS, Kobashigawa, JA, Xiao, H, Zhang, Z, Axelrod, DA, Lam, NN, Segev, DL, McAdams-DeMarco, MA, Randall, H, Hess, GP, Yuan, H, Vest, LS, Kasiske, BL & Schnitzler, MA 2019, 'Prescription opioid use before and after heart transplant: Associations with posttransplant outcomes', American Journal of Transplantation, vol. 19, no. 12, pp. 3405-3414. https://doi.org/10.1111/ajt.15565

@article{81620aeb09134a0d8b5ada9a1d3ffc58,

title = "Prescription opioid use before and after heart transplant: Associations with posttransplant outcomes",

abstract = "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% LCLaHR95% 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 1.101.331.61) 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 1.461.701.98) 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.",

keywords = "Scientific Registry for Transplant Recipients (SRTR), anesthesia/pain management, clinical research/practice, epidemiology, health services and outcomes research, heart transplantation, heart transplantation/cardiology, opioids, registries, risk assessment/risk stratification, risk factors",

author = "Lentine, {Krista L.} and Shah, {Kevin S.} and Kobashigawa, {Jon A.} and Huiling Xiao and Zidong Zhang and Axelrod, {David A.} and Lam, {Ngan N.} and Segev, {Dorry L.} and McAdams-DeMarco, {Mara Ann} and Henry Randall and Hess, {Gregory P.} and Hui Yuan and Vest, {Luke S.} and Kasiske, {Bertram L.} and Schnitzler, {Mark A.}",

note = "Funding Information: This work was conducted under the auspices of the Hennepin Healthcare Research Institute, contractor for the Scientific Registry of Transplant Recipients (SRTR), as a deliverable under contract no. HHSH250201000018C (U.S. Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation). As a U.S. Government–sponsored work, there are no restrictions on its use. The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the U.S. Government. This work was supported by a grant from the National Institutes of Health (NIH)/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) R01DK120518. NNL was supported by a KRESCENT New Investigator Award. The opinions, results, and conclusions reported in this article are those of the authors and are independent of the funding sources. The authors thank SRTR colleague Nan Booth, MSW, MPH, ELS, for manuscript editing. Publisher Copyright: {\textcopyright} 2019 The American Society of Transplantation and the American Society of Transplant Surgeons",

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doi = "10.1111/ajt.15565",

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T2 - Associations with posttransplant outcomes

AU - Lentine, Krista L.

AU - Shah, Kevin S.

AU - Kobashigawa, Jon A.

AU - Xiao, Huiling

AU - Zhang, Zidong

AU - Axelrod, David A.

AU - Lam, Ngan N.

AU - Segev, Dorry L.

AU - McAdams-DeMarco, Mara Ann

AU - Randall, Henry

AU - Hess, Gregory P.

AU - Yuan, Hui

AU - Vest, Luke S.

AU - Kasiske, Bertram L.

AU - Schnitzler, Mark A.

N1 - Funding Information: This work was conducted under the auspices of the Hennepin Healthcare Research Institute, contractor for the Scientific Registry of Transplant Recipients (SRTR), as a deliverable under contract no. HHSH250201000018C (U.S. Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation). As a U.S. Government–sponsored work, there are no restrictions on its use. The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the U.S. Government. This work was supported by a grant from the National Institutes of Health (NIH)/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) R01DK120518. NNL was supported by a KRESCENT New Investigator Award. The opinions, results, and conclusions reported in this article are those of the authors and are independent of the funding sources. The authors thank SRTR colleague Nan Booth, MSW, MPH, ELS, for manuscript editing. Publisher Copyright: © 2019 The American Society of Transplantation and the American Society of Transplant Surgeons

PY - 2019/12/1

Y1 - 2019/12/1

N2 - 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% LCLaHR95% 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 1.101.331.61) 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 1.461.701.98) 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.

AB - 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% LCLaHR95% 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 1.101.331.61) 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 1.461.701.98) 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.

KW - Scientific Registry for Transplant Recipients (SRTR)

KW - anesthesia/pain management

KW - clinical research/practice

KW - epidemiology

KW - health services and outcomes research

KW - heart transplantation

KW - heart transplantation/cardiology

KW - opioids

KW - registries

KW - risk assessment/risk stratification

KW - risk factors

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Prescription opioid use before and after heart transplant: Associations with posttransplant outcomes

Abstract

Keywords

ASJC Scopus subject areas

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