Association of Pre-Lung Transplant Opioid Use With Posttransplant Opioid Use and Outcomes

Preoperative opioid use (OU) is a strong risk factor for poor postoperative outcomes in other surgical populations but has not been explored in lung transplant (LT) recipients nationally.

The study identified adult (aged ≥18 years) US lung transplant (LT) recipients from 2011 to 2021 in the Scientific Registry of Transplant Recipients with prescription data through a pharmacy data set. Posttransplantation ventilatory support, infection, and mortality by pretransplantation OU (prescription fill ≤6 months before transplantation) were compared using multivariable regression.

Among 17,285 LT recipients, 17.9% had pretransplantation OU. The odds of posttransplantation opioid prescription fill were 3.18-fold higher 0 to 6 months after transplantation (adjusted odds ratio [aOR], 3.18; 95% CI, 2.91-3.47; P < .001) and 14.29-fold higher 6 to 12 months after transplantation (aOR, 14.29; 95% CI, 12.61-16.19; P < .001) among LT recipients with vs without pretransplantation OU. Pretransplantation OU was associated with 16% higher posttransplantation mortality (adjusted hazard ratio, 1.16; 95% CI, 1.09-1.25; P < .001) and a higher risk of ventilator use >48 hours (aOR, 1.14; 95% CI, 1.04-1.25; P = .006).

Pretransplantation OU was the strongest independent risk factor for posttransplantation OU and was associated with greater morbidity and mortality. Reducing pretransplantation and posttransplantation OU could benefit LT recipients and should be explored.