Pretransplant Opioid Use and Survival After Lung Transplantation

Abstract

Background. The impact of opioid use in lung transplant candidates on posttransplant outcomes is unknown. Studies on opioid therapy in kidney and liver transplant candidates have suggested increased risk of graft failure or death. We sought to analyze the relationship between pretransplant opioid use in lung transplant candidates and retransplant-free survival. Methods. We retrospectively reviewed adult patients transplanted consecutively between November 2004 and August 2015. The exposure was any opioid use at time of transplant listing and primary outcome was retransplant-free survival, analyzed via Cox regression model adjusted for recipient age, gender, ethnicity, diagnosis, and bridging status. Secondary outcomes included duration of ventilation, intensive care unit and hospital length of stay, 3-month and 1-year survival, continuing opioid use at 1 year, and time to onset of chronic lung allograft dysfunction. Results. The prevalence of opioid use at time of listing was 14% (61/425). Median daily oral morphine equivalent dose was 31 mg (18–54). Recipient ethnicity was associated with pretransplant opioid use. Opioid use at time of listing did not increase risk of death or retransplantation in an adjusted model (hazard ratio 1.12 [95% confidence interval 0.65-1.83], P = 0.6570). Secondary outcomes were similar between groups except hospital length of stay (opioid users 35 versus nonusers 27 d, P = 0.014). Continued opioid use at 1-year posttransplant was common (27/56, 48%). Conclusions. Pretransplant opioid use was not associated with retransplant-free survival in our cohort and should not necessarily preclude listing. Further work stratifying opioid use by indication and the association with opioid use disorder would be worthwhile.

Multimodal opioid‐sparing pain management after lung transplantation and the impact of liposomal bupivacaine intercostal nerve block

“…In kidney transplant recipients, pre‐transplant opioid use was associated with an increased risk of graft failure and mortality–an effect that was compounded by concomitant benzodiazepine use 8 . A similar study evaluating pre‐transplant opioid use and outcomes in lung transplant recipients did not find a difference in risk of death or graft loss 19 . However, the low daily opioid dose may have limited the ability to detect a difference, as outcomes have historically been worse in heavy opioid users 8,9 .…”

“…8 A similar study evaluating pre-transplant opioid use and outcomes in lung transplant recipients did not find a difference in risk of death or graft loss. 19 However, the low daily opioid dose may have limited the ability to detect a difference, as outcomes have historically been worse in heavy opioid users. 8,9 In contrast, post lung transplant opioid dependence has been linked with increased mortality and worse lung function, and many patients remain on opioids chronically.…”

“…However, the low daily opioid dose may have limited the ability to detect a difference, as outcomes have historically been worse in heavy opioid users 8,9 . In contrast, post lung transplant opioid dependence has been linked with increased mortality and worse lung function, and many patients remain on opioids chronically 10,19 . These studies highlight the need to carefully screen for opioid use pre‐transplant and also to minimize opioid use post‐transplant to avoid any negative effects on graft and patient survival.…”

Consensus document for the selection of lung transplant candidates: An update from the International Society for Heart and Lung Transplantation

“…(120) Opioids: The safety of pre-lung transplant opioid use on transplant outcomes has not been widely studied. (121,122) The risk and benefit of opioids prescribed to lung transplant candidates to palliate symptoms of pain or dyspnea should be considered on an individual basis. Medication assisted treatment (e.g., buprenorphine, naltrexone, methadone) for opioid use disorder has not been studied in advanced lung disease patients, and consultation with a psychiatrist or addictions specialist may be indicated in such cases.…”

The Year 2020 in Review: Noteworthy Literature for Thoracic Transplant Anesthesiologists

“…Vahidy et al 4 sought to evaluate the impact of pretransplant opioid use on survival after LTx, as similar analysis in other transplant populations has demonstrated higher rates of graft failure and death, including kidney and liver recipients. Through retrospective analysis of adult patients undergoing LTx at their institution between 2004 and 2015 (n = 425), the group identified a preoperative prevalence of opioid use of 14% (n = 61) at the time of listing, with a median daily oral morphine equivalent dose of 31 mg (range = 18-54 mg).…”