Kidney Week

Abstract: SA-PO043

Benzodiazepines and Opioid Co-Prescriptions: Outcome Implications in Kidney Transplant Recipients

Session Information

• Transplantation: Clinical Outcomes
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 1802 Transplantation: Clinical

Authors

• Lam, Ngan, University of Alberta, Edmonton, Alberta, Canada

Ngan Lam,

• Schnitzler, Mark, Saint Louis Univ, St Louis, Missouri, United States

Mark Schnitzler,

• Axelrod, David A., Lahey Hospital and Clinic, Burlington, Massachusetts, United States

David A. Axelrod,

• Dharnidharka, Vikas R., Washington University School of Medicine, St Louis, Missouri, United States

Vikas R. Dharnidharka,

• Segev, Dorry L., Johns Hopkins University, Baltimore, Maryland, United States

Dorry L. Segev,

• Naik, Abhijit S., University of Michigan, St. Louis, Michigan, United States

Abhijit S. Naik,

• Xiao, Huiling, St. Louis University, St. Louis, Missouri, United States

Huiling Xiao,

• Hess, Gregory P., LDI University of Pennsylvania/Symphony Health, Conshohocken, Pennsylvania, United States

Gregory P. Hess,

• Kasiske, Bertram L., Hennepin County Medical Center, Minneapolis, Minnesota, United States

Bertram L. Kasiske,

• Alhamad, Tarek, Washington University in St. Louis, St. Louis, Missouri, United States

Tarek Alhamad,

• Lentine, Krista L., Saint Louis University, St. Louis, Missouri, United States

Krista L. Lentine,

Background

Recent studies identify coprescription of benzodiazepines and opioids as a risk factor for adverse outcomes in the general population. We previously described associations of opioid use before kidney transplantation (KTx) with mortality after KTx, but the implications of benzodiazepine use in the KTx population have not been described.

Methods

We examined a novel linkages of SRTR registry data with records from a pharmaceutical claims warehouse (2008-2015) to characterize benzodiazepine and opioid use in the year before KTx and associations (adjusted hazard ratio, _{95% LCL}aHR_{95% UCL}) with death over 1yr post-KTx.

Results

Among 75,430 KTx recipients with available medication data in the year prior to KTx, 7.3% & 43.1% filled a prescription for a benzodiazepine or opioid in the pre-KTx year. Use of both medications was more common among recipients who were white, unemployed, and received prior KTx. Benzodiazepine use rose with higher opioid use, from 3.2% among opioid non-uses to 10.2% among those with highest level opioid use (Fig 1).

Compared to non-users, high-level pre-KTx benzodiazepine use was associated with a 51% (aHR _1.141.51_1.99) increased risk of death in the year after transplant. Opioid use bore a strong graded relationship with post-KTx survival, and prognostic impact high pre-KTx benzodiazepines was preserved after adjustment for opioids, although an interaction was not present (aHR _1.041.37_1.83) (Fig 2).

Conclusion

Benzodiazepines use is correlated with opioid fills before KTx, and these agents have additive associations with post-KTx mortality. Future research is needed to examine mechanisms of these associations and impact of reducing coprescription on improving outcomes after KTx.