Prevalence and Patterns of Opioid Use Before and After Liver Transplantation

Abdominal Organ Transplant Article of the Month

Abstract:

Background. Opioid use in liver transplantation is poorly understood and has potential associated morbidity.

Methods. Using a national data set of employer-based insurance claims, we identified 1257 adults who underwent liver transplantation between December 2009 and February 2015. We categorized patients based on their duration of opioid fills over the year before and after transplant admission as opioid naive/no fills, chronic opioid use (≥120 d supply), and intermittent use (all other use). We calculated risk-adjusted prevalence of peri-transplant opioid fills, assessed changes in opioid use after transplant, and identified correlates of persistent or increased opioid use post-transplant.

Results. Overall, 45% of patients filled ≥1 opioid prescription in the year before transplant (35% intermittent use, 10% chronic). Post-transplant, 61% of patients filled an opioid prescription 0–2 months after discharge, and 21% filled an opioid between 10–12 months after discharge. Among previously opioid-naive patients, 4% developed chronic use post-transplant. Among patients with pre-transplant opioid use, 84% remained intermittent or increased to chronic use, and 73% of chronic users remained chronic users after transplant. Pre-transplant opioid use (risk factor) and hepatobiliary malignancy (protective) were the only factors independently associated with risk of persistent or increased post-transplant opioid use.

Conclusions. Prescription opioid use is common before and after liver transplant, with intermittent and chronic use largely persisting, and a small development of new chronic use post-transplant. To minimize the morbidity of long-term opioid use, it is critical to improve pain management and optimize opioid use before and after liver transplant.

Expert summary by Cara Crouch, MD

References:

1. Cron D, Tincopa M, Lee J, Waljee A, Hammoud A, Brummet C, Waljee J, Englesbe M, Sonnenday C. Prevalence and Patterns of Opioid Use Before and After Liver Transplantation. Transplantation. 2021; 105(1):100-107
2. Braun H, Ascher N. Opioid Use and Liver Transplantation. Transplantation. 2021; 105(1):25-26