Opioid Prescription, Morbidity, and Mortality in US Transplant Recipients
Opioid Prescription, Morbidity, and Mortality in US Transplant Recipients
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DOI：
10.1097/tp.0000000000002057
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发表时间：
2018-06-01
期刊：
影响因子：
6.2
通讯作者：
Kimmel, Paul L.
中科院分区：
文献类型：
--
作者：
Abbott, Kevin C.;Fwu, Chyng-Wen;Kimmel, Paul L.
背景资料。疾病控制和预防中心的指南建议在开阿片类药物治疗慢性疼痛时要谨慎。肾移植(KTX)受者中阿片类药物处方(OpRx)的特点尚未在全国人群中得到描述。方法：研究方法。我们使用2006-2010年的美国肾脏数据系统文件，评估了流行的KTX接受者中OpRx的患病率，以及相关的持续时间(长期，定义为一年=90天)和剂量(以吗啡毫克当量/天=90)与结果、死亡和移植物丢失的关系，使用2006-2010年美国肾脏数据系统文件，包括用于药物确定的Medicare Part D部分。COX模型控制了受者的因素。结果。在2010年流行队列中的36,486名KTX接受者中，约有14.6%的人有长期的OpRx。KTX后与长期OpRx的相关性最强的是KTX前的长期OpRx(%；调整后的优势比，95%可信区间，95.274.2-122.1)。与KTX后长期使用OpRx或短期使用OpRx的患者相比，长期使用OpRx的KTX患者的死亡率和移植物丢失的风险更高。在长期服用>；=90毫克吗啡当量或更高剂量的受者中，这种风险最高(调整后的危险比，95%可信区间，死亡分别为1.61，1.24-2.10，移植物丢失为1.33，1.05-1.67)。结论。与不服用或短期服用OpRx不同，长期，尤其是长期大剂量的OpRx与美国KTX受者死亡和移植物丢失的风险增加有关。因果关系无法推断，OpRx可能是疾病的标志。然而，用毒性较小的干预措施有效地治疗KTX接受者的疼痛并减少OpRx值得考虑。
Background. Centers for Disease Control and Prevention guidelines recommend caution in prescribing opioids for chronic pain. The characteristics of opioid prescription (OpRx) among kidney transplant (KTx) recipients have not been described in a national population. Methods. We assessed OpRx prevalence among prevalent KTx recipients, and associated duration (long-term, defined as >= 90 days in a year) and dosing (in morphine milligram equivalents per day of = 90) with outcomes, death and graft loss, among incident KTx recipients using 2006-2010 US Renal Data System files, including Medicare Part D for medication ascertainment. Cox models controled for recipient factors. Results. Of 36,486 KTx recipients in the 2010 prevalent cohort, approximately 14.6% had long-term OpRx. The strongest association with long-term OpRx after KTx was longterm OpRx before KTx (64%; adjusted odds ratio, 95% confidence interval, 95.2, 74.2-122.1). Incident KTx recipients with longterm OpRx had increased risk of mortality and graft loss compared with those without OpRx or short-term OpRx after KTx. This risk was highest among recipients with long-term OpRx doses of >= 90 morphine milligram equivalents or higher per day (adjusted hazard ratio, 95% confidence interval, 1.61, 1.24-2.10 for death, and 1.33, 1.05-1.67 for graft loss, respectively). Conclusions. In contrast to either no or short-term OpRx, long-term, and especially long-term high-dose OpRx, is associated with increased risk of death and graft loss in US KTx recipients. Causal relationships cannot be inferred, and OpRx may be an illness marker. Nevertheless, efforts to treat pain effectively in KTx recipients with less toxic interventions and decrease OpRx deserve consideration.