Chronic opioid analgesic usage post‐kidney transplantation and clinical outcomes
Chronic opioid analgesic usage post‐kidney transplantation and clinical outcomes
复制标题
肾移植后慢性阿片类镇痛药的使用和临床结果
作者：
S. Kulshrestha;F. Barrantes;M. Samaniego;F. Luan
慢性阿片类药物使用（COU）在符合肾移植条件的终末期肾病（ESRD）患者中很常见，并与较差的移植后结局相关。肾移植后COU的程度及其对移植结果的影响仍然未知。我们进行了一项单中心回顾性研究，旨在描述第一年COU的患病率，确定COU的预测因素，并确定COU对移植后结局的影响，包括第一年的住院率和急性排斥反应，以及长期患者和移植物存活率。在1045例肾移植患者中，119例（11.4%）在肾移植后第一年内需要继续门诊处方阿片类镇痛药，主要用于非手术相关疼痛（85%）。移植前COU阳性史是移植后第一年COU的最强预测因素（调整后比值比[AOR] 4.31，p < 0.001）。COU患者在第一年住院的频率更高（AOR 2.48，p = 0.001，1次或2次住院，AOR 6.03，p < 0.001，≥3次住院），但急性排斥反应发生率相似（19.3% vs. 15.7%，p = 0.31）。然而，在长期随访期间，患者和/或死亡删失的肾脏存活率没有差异。在有临床指征和适当监督的情况下，肾移植后早期COU似乎不会影响死亡和死亡删失的移植物衰竭风险。
Chronic opioid usage (COU) is common among patients with end‐stage renal disease (ESRD) qualified for kidney transplantation and associated with inferior post‐transplant outcomes. The magnitude of COU after kidney transplantation and its impact on transplant outcomes remain unknown. We performed a single‐center retrospective study aimed to describe the prevalence of COU during the first year, to identify the predictors of COU and to determine the impact of COU on post‐transplant outcomes including the rates of hospitalization and acute rejection during the first year, as well as long‐term patient and graft survival. Among 1045 kidney transplant patients, 119 (11.4%) had required continued outpatient prescription of opioid analgesics during the first year after kidney transplantation, mostly for non‐surgery‐related pain (85%). A positive history of COU prior to transplantation was the strongest predictor of COU in the first year post‐transplantation (adjusted odds ratio [AOR] 4.31, p < 0.001). Patients with COU had more often hospital admission during the first year (AOR 2.48, p = 0.001, for 1 or 2 admissions, and AOR 6.03, p < 0.001 for ≥3 admissions), but similar rate of acute rejection (19.3% vs. 15.7%, p = 0.31). During long‐term follow‐up, however, the patient and/or death‐censored kidney survival was not different. COU early post‐kidney transplantation, when clinically indicated and properly supervised, does not appear to affect the risk of death and death‐censored graft failure.