TY - JOUR
T1 - Survival implications of prescription opioid and benzodiazepine use in lung transplant recipients
T2 - Analysis of linked transplant registry and pharmacy fill records
AU - Lentine, Krista L.
AU - Salvalaggio, Paolo R.
AU - Caliskan, Yasar
AU - Lam, Ngan N.
AU - McAdams-DeMarco, Mara
AU - Axelrod, David
AU - Segev, Dorry L.
AU - Myaskovsky, Larissa
AU - Dew, Mary Amanda
AU - Bruschwein, Heather
AU - Levine, Deborah J.
AU - Sweet, Stuart
AU - Hess, Gregory P.
AU - Kasiske, Bertram L.
AU - Schnitzler, Mark A.
N1 - Funding Information:
KLL, MDD, DLS, GPH, and MAS receive funding from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) R01DK120518 . K.L.L. is supported by the Mid-America Transplant/Jane A. Beckman Endowed Chair in Transplantation. The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the US Government. The opinions, results, and conclusions reported in this article are those of the authors and are independent of the funding sources. An oral abstract describing portions of this work was presentated at the virtual American Transplant Congress, June 2020.
Funding Information:
KLL, MDD, DLS, GPH, and MAS receive funding from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) R01DK120518. K.L.L. is supported by the Mid-America Transplant/Jane A. Beckman Endowed Chair in Transplantation. The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the US Government. The opinions, results, and conclusions reported in this article are those of the authors and are independent of the funding sources. An oral abstract describing portions of this work was presentated at the virtual American Transplant Congress, June 2020.
Publisher Copyright:
© 2021 International Society for Heart and Lung Transplantation
PY - 2021/6
Y1 - 2021/6
N2 - Background: Prescription opioid and benzodiazepine use have been associated with morbidity and mortality among some groups of solid organ transplant recipients, but implications for outcomes among lung transplant patients are not well described. Methods: We conducted a retrospective cohort study using linked national transplant registry and pharmaceutical records to characterize the associations between benzodiazepine and opioid prescription fills in the years before and after lung transplant (2006-2017), with risk-adjusted posttransplant survival (adjusted hazard ratio, LCLaHRUCL). Results: Among 11,568 recipients, 33.7% filled an opioid prescription, and 25.8% filled a benzodiazepine prescription before transplant. Compared to patients without prescriptions, those who filled both short- and long-acting benzodiazepine prescriptions before transplant had 2-fold higher mortality in the first year posttransplant (aHR, 1.392.123.21), after adjustment for baseline factors and opioid fills, while pretransplant opioid fills were not associated with posttransplant mortality after adjustment for benzodiazepine fills. Pretransplant opioid and benzodiazepine use strongly predicted more use after transplant. Fills of both short- and long-acting benzodiazepines in the first year posttransplant were associated with 77% increased mortality >1-to-2 years posttransplant (aHR, 1.061.772.96). Compared with no posttransplant opioid fills, there was a dose-dependent association between first-year opioid fills and subsequent adjusted mortality risk (level 2: aHR, 1.171.501.92 to level 4: aHR, 1.562.012.59). These effects were independent, and interactions were not detected. Conclusions: Benzodiazepine prescription fills before and after lung transplant, and opioid fills after transplant, are independently associated with posttransplant mortality. Review of benzodiazepine and opioid use history is relevant to risk-stratifying patients before and after lung transplant.
AB - Background: Prescription opioid and benzodiazepine use have been associated with morbidity and mortality among some groups of solid organ transplant recipients, but implications for outcomes among lung transplant patients are not well described. Methods: We conducted a retrospective cohort study using linked national transplant registry and pharmaceutical records to characterize the associations between benzodiazepine and opioid prescription fills in the years before and after lung transplant (2006-2017), with risk-adjusted posttransplant survival (adjusted hazard ratio, LCLaHRUCL). Results: Among 11,568 recipients, 33.7% filled an opioid prescription, and 25.8% filled a benzodiazepine prescription before transplant. Compared to patients without prescriptions, those who filled both short- and long-acting benzodiazepine prescriptions before transplant had 2-fold higher mortality in the first year posttransplant (aHR, 1.392.123.21), after adjustment for baseline factors and opioid fills, while pretransplant opioid fills were not associated with posttransplant mortality after adjustment for benzodiazepine fills. Pretransplant opioid and benzodiazepine use strongly predicted more use after transplant. Fills of both short- and long-acting benzodiazepines in the first year posttransplant were associated with 77% increased mortality >1-to-2 years posttransplant (aHR, 1.061.772.96). Compared with no posttransplant opioid fills, there was a dose-dependent association between first-year opioid fills and subsequent adjusted mortality risk (level 2: aHR, 1.171.501.92 to level 4: aHR, 1.562.012.59). These effects were independent, and interactions were not detected. Conclusions: Benzodiazepine prescription fills before and after lung transplant, and opioid fills after transplant, are independently associated with posttransplant mortality. Review of benzodiazepine and opioid use history is relevant to risk-stratifying patients before and after lung transplant.
KW - benzodiazepines
KW - lung transplant
KW - mortality
KW - opioids
KW - pharmacy fills
UR - http://www.scopus.com/inward/record.url?scp=85103939617&partnerID=8YFLogxK
U2 - 10.1016/j.healun.2021.02.004
DO - 10.1016/j.healun.2021.02.004
M3 - Article
C2 - 33846078
AN - SCOPUS:85103939617
SN - 1053-2498
VL - 40
SP - 513
EP - 524
JO - Journal of Heart and Lung Transplantation
JF - Journal of Heart and Lung Transplantation
IS - 6
ER -