Krista L Lentine1, Paolo R Salvalaggio2, Yasar Caliskan3, Ngan N Lam4, Mara McAdams-DeMarco5, David Axelrod6, Dorry L Segev5, Larissa Myaskovsky7, Mary Amanda Dew8, Heather Bruschwein9, Deborah J Levine10, Stuart Sweet11, Gregory P Hess12, Bertram L Kasiske13, Mark A Schnitzler3. 1. Saint Louis Transplant Center, St. Louis, Missouri, USA. Electronic address: krista.lentine@health.slu.edu. 2. Hospital Israelita Albert Einstein, Sao Paulo, Brazil. 3. Saint Louis Transplant Center, St. Louis, Missouri, USA. 4. University of Calgary, Calgary, Alberta, Canada. 5. Johns Hopkins School of Medicine, Baltimore, Maryland, USA. 6. University of Iowa, Iowa City, Iowa, USA. 7. University of New Mexico, Albuquerque, New Mexico, USA. 8. University of Pittsburgh, Pittsburgh, Pennsylvania, USA. 9. University of Virginia School of Medicine, Charlottesville, Virginia, USA. 10. University of Texas, San Antonio, Texas, USA. 11. Washington University, St. Louis, Missouri, USA. 12. Drexel University, Philadelphia, Pennsylvania, USA. 13. Hennepin County Medical Center, Minneapolis, Minnesota, USA.
Abstract
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.
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.
Authors: Krista L Lentine; Ngan N Lam; Huiling Xiao; Janet E Tuttle-Newhall; David Axelrod; Daniel C Brennan; Vikas R Dharnidharka; Hui Yuan; Mustafa Nazzal; Jie Zheng; Mark A Schnitzler Journal: Am J Nephrol Date: 2015-03-27 Impact factor: 3.754
Authors: Krista L Lentine; Kevin S Shah; Jon A Kobashigawa; Huiling Xiao; Zidong Zhang; David A Axelrod; Ngan N Lam; Dorry L Segev; Mara Ann McAdams-DeMarco; Henry Randall; Gregory P Hess; Hui Yuan; Luke S Vest; Bertram L Kasiske; Mark A Schnitzler Journal: Am J Transplant Date: 2019-09-12 Impact factor: 8.086
Authors: Henry B Randall; Tarek Alhamad; Mark A Schnitzler; Zidong Zhang; Sophia Ford-Glanton; David A Axelrod; Dorry L Segev; Bertram L Kasiske; Gregory P Hess; Hui Yuan; Rosemary Ouseph; Krista L Lentine Journal: Liver Transpl Date: 2017-03 Impact factor: 5.799
Authors: T M Egan; S Murray; R T Bustami; T H Shearon; K P McCullough; L B Edwards; M A Coke; E R Garrity; S C Sweet; D A Heiney; F L Grover Journal: Am J Transplant Date: 2006 Impact factor: 8.086
Authors: B W Pinsky; S K Takemoto; K L Lentine; T E Burroughs; M A Schnitzler; P R Salvalaggio Journal: Am J Transplant Date: 2009-11 Impact factor: 8.086
Authors: David A Axelrod; Wisit Cheungpasitporn; Suphamai Bunnapradist; Mark A Schnitzler; Huiling Xiao; Mara McAdams-DeMarco; Yasar Caliskan; Sunjae Bae; JiYoon B Ahn; Dorry L Segev; Ngan N Lam; Gregory P Hess; Krista L Lentine Journal: Kidney Med Date: 2021-10-22