An interesting study came out at the American Transplant Congress conference held last month in Philadelphia, Pa. Patients who were chronic opioid (pain medicine) user had a lower graft survival and higher mortality rate after kidney transplant. The study was performed at the University of Michigan with the 1064 patients who received kidney transplant between 2004 and 2008. Of that number, about 10% self-reported as being chronic opioid user (COU) before transplant. Pretransplant chronic opioid use is associated with worse patient survival at 1, 3, and 5 years claims Dr Barrentes who is a clinical transplant fellow at Michigan. The study was done at their own hospital with their own patients and they reported more graft failure and more death with patients who had a history of pain medicine abuse before transplant. The most used pain medicines were hydrocodone, propoxyphene, oxycodone and tramadol.
At 3 and 5 years after transplant, the death rate chronic opioid user was about twice as much as the one from the non-chronic opioid user. Respectively it was 18% vs 7.5% at 3 years and 21% vs 12% at 5 years. This is a pretty significant difference. The study did not identify the reasons behind the increase number in deaths but was pointing at the fact that patients with chronic pain may have morbidities like diabetes or any vascular conditions causing pain that affects graft and patient survival. Dr Barrentes was suggesting that a better screening could be done before transplant in order to be able to provide more support from social workers or psychologists after the kidney transplant.
The system could be the one to blame for these patients addicted to pain medicines. Sometimes it is just easier for a physician to sign the prescription for narcotics than trying to understand why a patient is hurting. This will not change overnight thought.