Opioid Pain Medications May Affect Liver Transplant Patients’ Survival

In a recent paper published in Liver Transplantation, researchers report that the use of opioid pain medications may play a significant role in patient outcomes following liver transplantation, according to Saint Louis University nephrologist and senior author Krista Lentine, M.D., Ph.D.

Krista Lentine, M.D.

SLU nephrologist Krista Lentine, M.D., Ph.D., leads a discussion at a recent conference. 

An analysis of nearly 30,000 patients undergoing liver transplantation in the United States between 2008 and 2014 found elevated death and organ loss rates in the first five years after transplantation among recipients with the highest use of opioid pain medications while on the waiting list.

Higher risks mainly emerged after the first transplant anniversary, a pattern that may in part reflect sustained opioid use. Sixty five percent of those with the highest level of opioid use on the waiting list continued moderate to high level use in the first year after transplantation.

The findings indicate that transplant candidates who require high levels of opioids should be carefully assessed and monitored before and after transplantation.

“Concerns for an epidemic of complications related to use of prescription opioids has not spared the population with end-stage liver disease,” Lentine said. “Risks of opioid-related toxicities may be even greater in patients with organ failure, due to altered drug metabolism and excretion. 

Henry Randall, M.D.
Henry Randall, M.D., associate professor of surgery at Saint Louis University 

First author and associate professor of surgery at Saint Louis University Henry Randall, M.D., concurred, noting “More work is needed to identify underlying mechanisms of mortality, determine the impact of decreasing opioid use before transplant, and design pain management strategies that improve patient outcomes.”

Lentine is the Medical Director of Living Donation at the Abdominal Transplant Center at SSM Health Saint Louis University Hospital, and is a Saint Louis University professor and SLUCare nephrologist. Randall is the Surgical Director of Abdominal Transplant at SSM Health Saint Louis University Hospital and a SLUCare surgeon.

Other researchers on the study include Tarek Alhamad, M.D., Mark A. Schnitzler, Ph.D., Zidong Zhang, Sophia Ford-Glanton, M.D., David A. Axelrod, M.D., Dorry L. Segev, M.D., Ph.D., Bertram L. Kasiske, M.D., Gregory P. Hess, M.D., Hui Yuan, M.D., and Rosemary Ouseph, M.D.

Established in 1836, Saint Louis University School of Medicine has the distinction of awarding the first medical degree west of the Mississippi River. The school educates physicians and biomedical scientists, conducts medical research, and provides health care on a local, national and international level. Research at the school seeks new cures and treatments in five key areas: cancer, liver disease, heart/lung disease, aging and brain disease, and infectious diseases.