Pre-Transplant Opioid Use is Not Associated with Overall Graft Survival in Lung Transplant Recipients

Abstract

Purpose The impact of opioid use in lung transplant (LTx) candidates on post-transplant outcomes is unknown. Previous studies on opioid therapy in kidney and liver transplant candidates have suggested increased risk of graft failure or death. We sought to test the association between pre-transplant opioid use in LTx candidates and overall retransplant-free survival. Methods We retrospectively reviewed patients transplanted between Nov 2004 - Aug 2015. The exposure was any opioid use at time of assessment. Our primary outcome was retransplant-free survival. Secondary outcomes included daily oral morphine equivalent (OME) dose in a Cox regression model, duration of ventilation, ICU and hospital LOS, 3 month and 1 year survival, and continuing use at 1 year. Results The prevalence of opioid use at assessment was 14% (61/425). Median daily OME dose was 31mg (18-54). Recipient race was associated with pre-transplant opioid use (Table 1). Opioid use was not associated with overall retransplant-free survival via log rank (p=0.08, Figure 1) [no change after excluding ventilation/ECMO bridging cases] or in a dose-dependent Cox model (HR 1.07 per OME [95%CI 0.12-4.55], p=0.94). All secondary outcomes were similar between groups except hospital LOS (opioid users 35 vs. non-opioid users 27 days, p=0.014). Continued opioid use in survivors at 1 year post-LTx was common (27/56, 48%). Conclusion Pre-transplant opioid use was not associated with overall post-transplant survival in our cohort and should not preclude listing. Further work stratifying opioid use by indication and the association with opioid use disorder would be worthwhile. The impact of opioid use in lung transplant (LTx) candidates on post-transplant outcomes is unknown. Previous studies on opioid therapy in kidney and liver transplant candidates have suggested increased risk of graft failure or death. We sought to test the association between pre-transplant opioid use in LTx candidates and overall retransplant-free survival. We retrospectively reviewed patients transplanted between Nov 2004 - Aug 2015. The exposure was any opioid use at time of assessment. Our primary outcome was retransplant-free survival. Secondary outcomes included daily oral morphine equivalent (OME) dose in a Cox regression model, duration of ventilation, ICU and hospital LOS, 3 month and 1 year survival, and continuing use at 1 year. The prevalence of opioid use at assessment was 14% (61/425). Median daily OME dose was 31mg (18-54). Recipient race was associated with pre-transplant opioid use (Table 1). Opioid use was not associated with overall retransplant-free survival via log rank (p=0.08, Figure 1) [no change after excluding ventilation/ECMO bridging cases] or in a dose-dependent Cox model (HR 1.07 per OME [95%CI 0.12-4.55], p=0.94). All secondary outcomes were similar between groups except hospital LOS (opioid users 35 vs. non-opioid users 27 days, p=0.014). Continued opioid use in survivors at 1 year post-LTx was common (27/56, 48%). Pre-transplant opioid use was not associated with overall post-transplant survival in our cohort and should not preclude listing. Further work stratifying opioid use by indication and the association with opioid use disorder would be worthwhile.