Systematic review of the impact of pre- and post-solid organ transplant chronic opioid use on recipient outcomes

ABSTRACT

Background: Chronic opioid use (COU) has been associated with negative outcomes in the general population but has not been systematically evaluated in solid organ transplant (SOT) recipients. This is a systematic review of the impact of pre- and post-transplant COU on recipient outcomes. Method(s) Electronic searches were performed in Medline, Embase, and Web of Science through date of inception to December 2021 for SOT and COU. A search alert was also conducted through Google Scholar. Literature was uploaded and managed through Covidence software. To reduce bias, title and s were independently screened and relevant articles underwent independent full text review. Conflicts at either stage were resolved by the senior author. Result(s) Literature search yielded 25,190 records and 8,258 were identified by Covidence as duplicate and removed. After title and screening of the remainder, 482 studies were read for eligibility, with 22 included in final assessment (kidney = 10;lung = 4;liver = 7;heart = 1). Ten studies (45.5%) were retrospective, 10 (45.5%) database analyses, and 2 (9.0%) were alternative methodology. Demographic differences and safety outcomes were the focus of most studies. Patient survival was assessed in 13 studies (59.1%). COU increased patient death in 9 (69.2%) of these studies with the remaining showing no impact on survival. Increased patient morality was noted in the following organ studies heart = 1, kidney = 5, liver = 2, lung = 1. Depending on the allograft included in the study, COU had varying impacts on length of stay, hospital readmissions, and COU post-transplant. Discussion(s) The impact of COU on transplant outcomes is largely confined to retrospective and database analyses. With findings demonstrating a negative impact of COU on post-transplant survival, a more robust assessment of opioid minimization and sparing strategies on post-transplant outcomes is needed.