Patient-reported Opioid use and Pain Management After Living Kidney Donation

This study evaluated donor-reported opioid use and pain management outcomes after living donor nephrectomy at a single center. Prospective data were collected through an automated text-messaging platform to assess postdischarge pain intensity, perceived pain control, and use of prescribed opioids for acute postoperative pain.

This prospective study was conducted at a large academic health system in Pennsylvania. Eligible participants were adult living kidney donors (aged 18 y and older) who underwent donor nephrectomy between July 2021 and March 2023. Data were collected using an automated text-messaging system from hospital discharge through postoperative day 28.

Of the eligible participants, 75 (71%) consented to participate. Donors who consented to follow-up did not differ significantly from those who did not consent in terms of demographic or perioperative characteristics. Inpatient opioid use and discharge prescribing practices were similar across groups. Of participants who responded at each follow-up, the median (interquartile range) self-reported pain intensity on day 4 was 4.0 (3.0-5.0) and decreased to 1.0 (0.0-2.0) by day 21. The median (interquartile range) perceived pain control increased to 10.0 (9.0-10.0) by day 14, with 3 (8.1%) of participants reporting opioid use by this time.

From a systems perspective, these findings underscore the need to recalibrate default discharge prescribing practices. Implementing standardized order sets and feedback mechanisms may reduce excess opioid supply while maintaining living kidney donor comfort.