Opioids and Kidney Transplantation

Abstract

The United States has faced an unprecedented opioid crisis in recent years, which has led to an increase in opioid overdose-related deaths and, consequently, an increase in the number of potential deceased donors available for transplantation. This new pool of potential organ donors is composed of younger donors with higher infectious disease transmission risk. The use of organs from these donors requires appropriate patient education, informed consent, and post-transplant monitoring practices. Prescription opioid use is also an important component of the evaluation of transplant and living donor candidates because it may impact outcomes and eligibility for the procedures. In kidney transplant recipients, prescription opioid use predicts a higher risk of mortality, graft loss, and post-transplant complications. These effects seem to be proportional to the levels of opioid use, and to parallel patterns in other transplant populations such as liver, heart and lung recipients. Among living kidney donors, predonation prescription opioid use is associated with an increased risk of re-admission after nephrectomy. Overall, the opioid epidemic creates educational needs for patients awaiting deceased donor transplant, and also impacts the evaluation and care of transplant candidates. Among transplant candidates and recipients, the identification of patients with chronic opioid use should prompt multidisciplinary evaluation and management strategies to minimize risks.

Keywords: Kidney transplantation; drug misuse; graft loss; mortality; opioid analgesics; pain.

Figure 1.. Timeline of the three waves of opioid overdose-associated deaths.

The first wave involved an increased number of opioid prescriptions in the 1990s. The second wave was due to heroin-related overdoses. The third wave began in 2013 with the contribution of illicitly manufactured fentanyl that has caused an increase in overdose deaths involving synthetic opioids (2).