Opiate use trends after liver transplantation and the factors associated with post-transplant opiate dependence.
Siddiqui M, Kaur R, Dhoop S, Sulejmani N, and Salgia R. Opiate use trends after liver transplantation and the factors associated with post-transplant opiate dependence. Am J Transplant 2018; 18:272.
Am J Transplant
Aims Our study aims to determine predictive factors leading to post-liver transplant (LT) opioid dependence. Methods A retrospective chart review was conducted including LT recipients from July 2013-June 2016. Patients were excluded if they had a history of other major surgery or trauma. A linear logistic regression was performed to predict opioid use in terms of oral Morphine equivalents, fitting separate models for time from LT. The change over time in opiate use was also tested using a McNemar's test. Results The results of the multivariate analysis revealed that opioid use pre-LT was associated with increased risk of opiate use post-LT, OR ranging from 2.08-3.57 between 3 months to 2 years post-LT. The concurrent use of psychotropic medications (for anxiety, depression or bipolar disorder) increased the likelihood of opiate use at 1 and 2 years post-LT. Patients were at a lower risk of developing post-LT opiate dependence if they were female or had a strong support system. (Table 1). McNemar's test revealed that the prevalence of ongoing opiate use did decrease from 85.6% at 1 month post-LT to 13.3% at 2 years post-LT. (Table Presented) Conclusion This study reveals factors associated with increased post-LT opiate dependence including pre-LT opiate use, concurrent use of psychotropic medications and a history of prior alcohol dependence. Importantly a strong support system is associated with lower risk for post-LT opiate dependence. Ongoing efforts to recognize patients at high risk for opiate dependence allow the transplant community to help curb the reliance on opioid analgesics and to seek out alternative methods of pain management.