Chronic narcotic use increases mortality rates in heart transplantation
St John G, Chamogeorgakis T, Nemeh H, Tita C, Selektor Y, Lanfear D, and Williams C. Chronic narcotic use increases mortality rates in heart transplantation. Am J Transplant 2018;18(Suppl 4):645.
Am J Transplant
Purpose: In kidney and liver transplantation, chronic narcotic use pre and posttransplant has been associated with an increased risk for rejection and early graft loss. There is a paucity of information on the adverse clinical outcomes associated with chronic narcotic use in heart transplant (HT) recipients. Methods: We conducted a retrospective chart review of adults who underwent HT at our institution from January 1, 2007 to June 30, 2016 using electronic medical records. Patients were stratified into groups by narcotic use. Chronic narcotic use (CNU) was defi ned as positive or negative at 6 months prior to transplant (pre transplant) and 6 months post-transplant. Univariate two-group comparisons were carried out using independent two-group t-tests for continuous variables, and chisquare tests for categorical variables. Survival distributions were compared between groups using log-rank tests. Results: 115 underwent HT, 81% were male, mean age 53.8 ±11 years, 48% white and 43% black. CNU pre transplant (N=26) had more illicit drug use (58% vs 28% p=.005), psychiatric history (77% vs 49% p=.013) and criminal history (38% vs 16% P=.012) than those without narcotic use pre-transplant. CNU post-transplant (N=32) had more illicit drug use (50% vs 29% p=.033), psychiatric history (75% vs 48% p=.010) and criminal history (38% vs 14% P=.006) than those without narcotic use post-transplant. No differences were observed in the rate of rejection amongst the groups. Table 1 contains the median survival time in months along with 1-, 3-, and 5-year survival probabilities with their standard errors (SE) of both groups. The 1-, 3-and 5-year survival is worse in patients with CNU post-transplant. Table 1: Survival by Narcotics Variable Median survival time in months (95% CI) 1-year survival probability (SE) 3-year survival probability (SE) 5-year survival probability (SE) P-Value No narcotics pre transplant 119.6 (109.6, N/A) 0.898 (0.03) 0.835 (0.041) 0.835 (0.041) 0.098 Narcotics pre transplant N/A (20.5, N/A) 0.769 (0.08) 0.690 (0.09) 0.690 (0.09) No narcotics post-transplant 119.6 (109.6, N/A) 0.916 (0.03) 0.887 (0.04) 0.887 (004) 0.002 Narcotics post-transplant N/A (19.2, N/A) 0.750 (0.08) 0.625 (0.09) 0.590 (0.09) Conclusion. Patients without CNU post-transplant have higher survival probabilities at each of the three time points than those with CNU post-transplant. Additional studies are warranted to confi rm observed associations.