Association between Posttransplant Opioid Use and Immunosuppressant Therapy Adherence among Renal Transplant Recipients

Abstract

Introduction: Little is known about the effect of posttransplant opioid use on adherence to immunosuppressant therapy (IST) among adult renal transplant recipients (RTRs). Objective: The aim of this study was to examine the relationship between opioid use and IST adherence among adult RTRs during the first year posttransplant. Methods: Longitudinal data were analyzed from a retrospective cohort study examining US veterans undergoing renal transplant from October 1, 2007, through March 31, 2015. Data were collected from the US Renal Data System, Centers for Medicare and Medicaid Services Data (Medicare Part D), and Veterans Affairs pharmacy records. Dose of opioid prescriptions was collected and divided based on annual morphine milligram equivalent within a year of transplant. Proportion of days covered of greater than or equal to 80% indicated adherence to tacrolimus. Unadjusted and multivariable-adjusted logistic regression analyses were performed. Results: A study population of 1,229 RTRs included 258 with no opioid use, while 971 opioid users were identified within the first year after transplantation. Compared to RTRs without opioid usage, RTRs with opioid usage had a lower probability of being adherent to tacrolimus in unadjusted logistic regression (odds ratio [OR] (95% confidence interval [CI]): 0.22 [0.07–0.72]) and adjusted logistic regression (OR [95% CI]: 0.11 [0.03–0.44]). These patterns generally remained consistent in unadjusted and adjusted main and sensitivity analyses. Conclusions: Findings indicate RTRs who use prescription opioids during the first year posttransplant, regardless of the dosage/amount, are less likely to be adherent to tacrolimus. Future studies are needed to better understand underlying causes of the association between opioid use and tacrolimus nonadherence.

A systematic review of opioid use and multimodal strategies in solid organ transplant recipients and living donors

“…Conversely, a single‐center analysis of 1045 kidney transplant recipients by a different study found no difference in allograft survival or patient survival but an increase in hospital readmissions among chronic opioid users 32 . Apart from survival end points, a registry trial assessing kidney transplant veterans via the US Renal Data System, Centers for Medicare and Medicaid Services Data (Medicare Part D), and Veterans Affairs pharmacy records demonstrated post‐transplant chronic opioid use was associated with significantly worse adherence to tacrolimus compared with nonopioid users 33 …”

“…The impact of post‐transplant opioid use on post‐transplant outcomes was described in three studies, all conducted in kidney transplant recipients 31–33 . Two assessed mortality with differing conclusions.…”

“…The impact of post-transplant opioid use on post-transplant outcomes was described in three studies, all conducted in kidney transplant recipients. [31][32][33] Two assessed mortality with differing conclusions. First, a 36,486 patient analysis from the US Renal Data System Files found an adjusted hazard ratio of 1.61 for death among kidney transplant recipients on >90 MME/day.…”

Substance use and solid organ transplantation in adolescents and young adults: Current findings and implications

“…Regardless, like other substances, opioid use may be associated with nonadherence. For example, among middle‐aged and older adult renal transplant recipients, increased opioid use has been associated with increased nonadherence 69 …”

“…For example, among middleaged and older adult renal transplant recipients, increased opioid use has been associated with increased nonadherence. 69 It is notable that there is also a lack of findings for other commonly used substances, such as stimulants, benzodiazepines, and illicit substances in this population. These types of substances are known to be experimented with by the general population.…”