Opioid Prescription, Morbidity, and Mortality in US Transplant Recipients
BACKGROUNDCenters for Disease Control and Prevention guidelines recommend caution in prescribing opioids for chronic pain. The characteristics of opioid prescription (OpRx) among kidney transplant (KTx) recipients have not been described in a national population. METHODSWe assessed OpRx prevalence a...
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| Veröffentlicht in: | Transplantation 2018-06, Vol.102 (6), p.994-1004 |
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| creator | Abbott, Kevin C Fwu, Chyng-Wen Eggers, Paul W Eggers, Anne W Kline, Prudence P Kimmel, Paul L |
| description | BACKGROUNDCenters for Disease Control and Prevention guidelines recommend caution in prescribing opioids for chronic pain. The characteristics of opioid prescription (OpRx) among kidney transplant (KTx) recipients have not been described in a national population.
METHODSWe assessed OpRx prevalence among prevalent KTx recipients, and associated duration (long-term, defined as ≥90 days in a year) and dosing (in morphine milligram equivalents per day of |
| doi_str_mv | 10.1097/TP.0000000000002057 |
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| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_5962376</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1989564847</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4797-72490ba5e4b909174385f53772945df9660fab5cdb50e754b0ce4b515b0c499d3</originalsourceid><addsrcrecordid>eNp9kV1PwjAUhhujEUR_gYnZpRcM27Vd6Y2JIX6QYCA6rptu66Q61tluEv69JSBBL-zN6cl5znu-ALhEcIAgZzfJbAAPXgQpOwJdRDEJYziEx6ALIUEhwph1wJlz7x6imLFT0Ik4RjyOWBeMp7U2Og9mVrnM6rrRpuoHz8amOtfNuh_IKt-4jSy9G-gqmL8GiZWVq0tZNcGLynStVdW4c3BSyNKpi53tgfnDfTJ6CifTx_HobhJmhHEWsohwmEqqSMohR4zgIS02bUWc0LzgcQwLmdIsTylUjJIUZh6liPoP4TzHPXC71a3bdKnyzNe2shS11Utp18JILX5HKr0Qb-ZLUD8xZrEXuN4JWPPZKteIpXaZKv08yrROID7kNCZDwjyKt2hmjXNWFfsyCIrNEUQyE3-P4LOuDjvc5_xs3QNsC6xM2SjrPsp2paxYKFk2i3-lvwHVtpMz</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1989564847</pqid></control><display><type>article</type><title>Opioid Prescription, Morbidity, and Mortality in US Transplant Recipients</title><source>MEDLINE</source><source>Journals@Ovid Complete</source><creator>Abbott, Kevin C ; Fwu, Chyng-Wen ; Eggers, Paul W ; Eggers, Anne W ; Kline, Prudence P ; Kimmel, Paul L</creator><creatorcontrib>Abbott, Kevin C ; Fwu, Chyng-Wen ; Eggers, Paul W ; Eggers, Anne W ; Kline, Prudence P ; Kimmel, Paul L</creatorcontrib><description>BACKGROUNDCenters for Disease Control and Prevention guidelines recommend caution in prescribing opioids for chronic pain. The characteristics of opioid prescription (OpRx) among kidney transplant (KTx) recipients have not been described in a national population.
METHODSWe assessed OpRx prevalence among prevalent KTx recipients, and associated duration (long-term, defined as ≥90 days in a year) and dosing (in morphine milligram equivalents per day of <50, 50-89, and ≥90) with outcomes, death and graft loss, among incident KTx recipients using 2006-2010 US Renal Data System files, including Medicare Part D for medication ascertainment. Cox models controlled for recipient factors.
RESULTSOf 36,486 KTx recipients in the 2010 prevalent cohort, approximately 14.6% had long-term OpRx. The strongest association with long-term OpRx after KTx was long-term OpRx before KTx (64%; adjusted odds ratio, 95% confidence interval, 95.2, 74.2-122.1). Incident KTx recipients with long-term OpRx had increased risk of mortality and graft loss compared with those without OpRx or short-term OpRx after KTx. This risk was highest among recipients with long-term OpRx doses of ≥90 morphine milligram equivalents or higher per day (adjusted hazard ratio, 95% confidence interval, 1.61, 1.24-2.10 for death, and 1.33, 1.05-1.67 for graft loss, respectively).
CONCLUSIONSIn contrast to either no or short-term OpRx, long-term, and especially long-term high-dose OpRx, is associated with increased risk of death and graft loss in US KTx recipients. Causal relationships cannot be inferred, and OpRx may be an illness marker. Nevertheless, efforts to treat pain effectively in KTx recipients with less toxic interventions and decrease OpRx deserve consideration.</description><identifier>ISSN: 0041-1337</identifier><identifier>ISSN: 1534-6080</identifier><identifier>EISSN: 1534-6080</identifier><identifier>DOI: 10.1097/TP.0000000000002057</identifier><identifier>PMID: 29319627</identifier><language>eng</language><publisher>United States: Copyright Wolters Kluwer Health, Inc. All rights reserved</publisher><subject>Adult ; Aged ; Analgesics, Opioid - administration & dosage ; Analgesics, Opioid - adverse effects ; Centers for Medicare and Medicaid Services, U.S ; Chronic Pain - diagnosis ; Chronic Pain - drug therapy ; Chronic Pain - mortality ; Drug Prescriptions ; Female ; Graft Survival - drug effects ; Humans ; Incidence ; Kidney Transplantation - adverse effects ; Kidney Transplantation - mortality ; Male ; Medicare Part D ; Middle Aged ; Prevalence ; Registries ; Retrospective Studies ; Risk Factors ; Time Factors ; Transplant Recipients ; United States - epidemiology ; Young Adult</subject><ispartof>Transplantation, 2018-06, Vol.102 (6), p.994-1004</ispartof><rights>Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4797-72490ba5e4b909174385f53772945df9660fab5cdb50e754b0ce4b515b0c499d3</citedby><cites>FETCH-LOGICAL-c4797-72490ba5e4b909174385f53772945df9660fab5cdb50e754b0ce4b515b0c499d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29319627$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Abbott, Kevin C</creatorcontrib><creatorcontrib>Fwu, Chyng-Wen</creatorcontrib><creatorcontrib>Eggers, Paul W</creatorcontrib><creatorcontrib>Eggers, Anne W</creatorcontrib><creatorcontrib>Kline, Prudence P</creatorcontrib><creatorcontrib>Kimmel, Paul L</creatorcontrib><title>Opioid Prescription, Morbidity, and Mortality in US Transplant Recipients</title><title>Transplantation</title><addtitle>Transplantation</addtitle><description>BACKGROUNDCenters for Disease Control and Prevention guidelines recommend caution in prescribing opioids for chronic pain. The characteristics of opioid prescription (OpRx) among kidney transplant (KTx) recipients have not been described in a national population.
METHODSWe assessed OpRx prevalence among prevalent KTx recipients, and associated duration (long-term, defined as ≥90 days in a year) and dosing (in morphine milligram equivalents per day of <50, 50-89, and ≥90) with outcomes, death and graft loss, among incident KTx recipients using 2006-2010 US Renal Data System files, including Medicare Part D for medication ascertainment. Cox models controlled for recipient factors.
RESULTSOf 36,486 KTx recipients in the 2010 prevalent cohort, approximately 14.6% had long-term OpRx. The strongest association with long-term OpRx after KTx was long-term OpRx before KTx (64%; adjusted odds ratio, 95% confidence interval, 95.2, 74.2-122.1). Incident KTx recipients with long-term OpRx had increased risk of mortality and graft loss compared with those without OpRx or short-term OpRx after KTx. This risk was highest among recipients with long-term OpRx doses of ≥90 morphine milligram equivalents or higher per day (adjusted hazard ratio, 95% confidence interval, 1.61, 1.24-2.10 for death, and 1.33, 1.05-1.67 for graft loss, respectively).
CONCLUSIONSIn contrast to either no or short-term OpRx, long-term, and especially long-term high-dose OpRx, is associated with increased risk of death and graft loss in US KTx recipients. Causal relationships cannot be inferred, and OpRx may be an illness marker. Nevertheless, efforts to treat pain effectively in KTx recipients with less toxic interventions and decrease OpRx deserve consideration.</description><subject>Adult</subject><subject>Aged</subject><subject>Analgesics, Opioid - administration & dosage</subject><subject>Analgesics, Opioid - adverse effects</subject><subject>Centers for Medicare and Medicaid Services, U.S</subject><subject>Chronic Pain - diagnosis</subject><subject>Chronic Pain - drug therapy</subject><subject>Chronic Pain - mortality</subject><subject>Drug Prescriptions</subject><subject>Female</subject><subject>Graft Survival - drug effects</subject><subject>Humans</subject><subject>Incidence</subject><subject>Kidney Transplantation - adverse effects</subject><subject>Kidney Transplantation - mortality</subject><subject>Male</subject><subject>Medicare Part D</subject><subject>Middle Aged</subject><subject>Prevalence</subject><subject>Registries</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Time Factors</subject><subject>Transplant Recipients</subject><subject>United States - epidemiology</subject><subject>Young Adult</subject><issn>0041-1337</issn><issn>1534-6080</issn><issn>1534-6080</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kV1PwjAUhhujEUR_gYnZpRcM27Vd6Y2JIX6QYCA6rptu66Q61tluEv69JSBBL-zN6cl5znu-ALhEcIAgZzfJbAAPXgQpOwJdRDEJYziEx6ALIUEhwph1wJlz7x6imLFT0Ik4RjyOWBeMp7U2Og9mVrnM6rrRpuoHz8amOtfNuh_IKt-4jSy9G-gqmL8GiZWVq0tZNcGLynStVdW4c3BSyNKpi53tgfnDfTJ6CifTx_HobhJmhHEWsohwmEqqSMohR4zgIS02bUWc0LzgcQwLmdIsTylUjJIUZh6liPoP4TzHPXC71a3bdKnyzNe2shS11Utp18JILX5HKr0Qb-ZLUD8xZrEXuN4JWPPZKteIpXaZKv08yrROID7kNCZDwjyKt2hmjXNWFfsyCIrNEUQyE3-P4LOuDjvc5_xs3QNsC6xM2SjrPsp2paxYKFk2i3-lvwHVtpMz</recordid><startdate>201806</startdate><enddate>201806</enddate><creator>Abbott, Kevin C</creator><creator>Fwu, Chyng-Wen</creator><creator>Eggers, Paul W</creator><creator>Eggers, Anne W</creator><creator>Kline, Prudence P</creator><creator>Kimmel, Paul L</creator><general>Copyright Wolters Kluwer Health, Inc. All rights reserved</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>201806</creationdate><title>Opioid Prescription, Morbidity, and Mortality in US Transplant Recipients</title><author>Abbott, Kevin C ; Fwu, Chyng-Wen ; Eggers, Paul W ; Eggers, Anne W ; Kline, Prudence P ; Kimmel, Paul L</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4797-72490ba5e4b909174385f53772945df9660fab5cdb50e754b0ce4b515b0c499d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Analgesics, Opioid - administration & dosage</topic><topic>Analgesics, Opioid - adverse effects</topic><topic>Centers for Medicare and Medicaid Services, U.S</topic><topic>Chronic Pain - diagnosis</topic><topic>Chronic Pain - drug therapy</topic><topic>Chronic Pain - mortality</topic><topic>Drug Prescriptions</topic><topic>Female</topic><topic>Graft Survival - drug effects</topic><topic>Humans</topic><topic>Incidence</topic><topic>Kidney Transplantation - adverse effects</topic><topic>Kidney Transplantation - mortality</topic><topic>Male</topic><topic>Medicare Part D</topic><topic>Middle Aged</topic><topic>Prevalence</topic><topic>Registries</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Time Factors</topic><topic>Transplant Recipients</topic><topic>United States - epidemiology</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Abbott, Kevin C</creatorcontrib><creatorcontrib>Fwu, Chyng-Wen</creatorcontrib><creatorcontrib>Eggers, Paul W</creatorcontrib><creatorcontrib>Eggers, Anne W</creatorcontrib><creatorcontrib>Kline, Prudence P</creatorcontrib><creatorcontrib>Kimmel, Paul L</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Abbott, Kevin C</au><au>Fwu, Chyng-Wen</au><au>Eggers, Paul W</au><au>Eggers, Anne W</au><au>Kline, Prudence P</au><au>Kimmel, Paul L</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Opioid Prescription, Morbidity, and Mortality in US Transplant Recipients</atitle><jtitle>Transplantation</jtitle><addtitle>Transplantation</addtitle><date>2018-06</date><risdate>2018</risdate><volume>102</volume><issue>6</issue><spage>994</spage><epage>1004</epage><pages>994-1004</pages><issn>0041-1337</issn><issn>1534-6080</issn><eissn>1534-6080</eissn><abstract>BACKGROUNDCenters for Disease Control and Prevention guidelines recommend caution in prescribing opioids for chronic pain. The characteristics of opioid prescription (OpRx) among kidney transplant (KTx) recipients have not been described in a national population.
METHODSWe assessed OpRx prevalence among prevalent KTx recipients, and associated duration (long-term, defined as ≥90 days in a year) and dosing (in morphine milligram equivalents per day of <50, 50-89, and ≥90) with outcomes, death and graft loss, among incident KTx recipients using 2006-2010 US Renal Data System files, including Medicare Part D for medication ascertainment. Cox models controlled for recipient factors.
RESULTSOf 36,486 KTx recipients in the 2010 prevalent cohort, approximately 14.6% had long-term OpRx. The strongest association with long-term OpRx after KTx was long-term OpRx before KTx (64%; adjusted odds ratio, 95% confidence interval, 95.2, 74.2-122.1). Incident KTx recipients with long-term OpRx had increased risk of mortality and graft loss compared with those without OpRx or short-term OpRx after KTx. This risk was highest among recipients with long-term OpRx doses of ≥90 morphine milligram equivalents or higher per day (adjusted hazard ratio, 95% confidence interval, 1.61, 1.24-2.10 for death, and 1.33, 1.05-1.67 for graft loss, respectively).
CONCLUSIONSIn contrast to either no or short-term OpRx, long-term, and especially long-term high-dose OpRx, is associated with increased risk of death and graft loss in US KTx recipients. Causal relationships cannot be inferred, and OpRx may be an illness marker. Nevertheless, efforts to treat pain effectively in KTx recipients with less toxic interventions and decrease OpRx deserve consideration.</abstract><cop>United States</cop><pub>Copyright Wolters Kluwer Health, Inc. All rights reserved</pub><pmid>29319627</pmid><doi>10.1097/TP.0000000000002057</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Aged Analgesics, Opioid - administration & dosage Analgesics, Opioid - adverse effects Centers for Medicare and Medicaid Services, U.S Chronic Pain - diagnosis Chronic Pain - drug therapy Chronic Pain - mortality Drug Prescriptions Female Graft Survival - drug effects Humans Incidence Kidney Transplantation - adverse effects Kidney Transplantation - mortality Male Medicare Part D Middle Aged Prevalence Registries Retrospective Studies Risk Factors Time Factors Transplant Recipients United States - epidemiology Young Adult |
| title | Opioid Prescription, Morbidity, and Mortality in US Transplant Recipients |
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