High Doses of Opioids Before Liver Transplant Often Increase Risk of Dying

by Özge Özkaya, PhD | March 10, 2017

Consuming high doses of opioid pain killers while waiting for a liver transplant can increase the risk of death and organ loss after the transplant, according to a study published in the journal Liver Transplantation.

This finding suggests it is important to closely monitor liver transplant candidates who need high doses of opioids, before and after the operation, paying special attention to their history of opioid use.

The study, “Survival implications of opioid use before and after liver transplantation,” was conducted by researchers at the Center for Abdominal Transplantation, Saint Louis University School of Medicine.

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

The study included almost 30,000 patients who underwent liver transplants in the U.S. between 2008 and 2014. It showed that higher risks of death and organ loss were seen mainly after the first year of the transplant, and that 65% of patients with the highest level of opioid drug use while on the waiting list for a liver transplant continued to use the drug at moderate-to-high level in the first year after the transplant. This suggests that the increased risk of death and organ loss may be associated, at least in part, with sustained opioid use.

The findings showed that, compared to patients who never used opioids, those on the highest level of opioid drug use on the waiting list had a 52% higher risk of dying in the first five years after transplant.

Liver transplantation candidates are evaluated in terms of the severity and complications of liver disease, other associated diseases, overall fitness, and psychosocial status, in order to select the candidates with lower risks of complications that may occur during liver transplant in the long term.

Doctors assess the drugs that the liver transplant candidates use to identify any health problems, areas that may require special care, such as the use of anti-clotting drugs, and possible drug interactions that might occur following the operation. This study underscores the importance of conducting such investigations with special attention to opioid pain killers.

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About the Author

Özge Özkaya, PhD Özge has a MSc. in Molecular Genetics from the University of Leicester and a PhD in Developmental Biology from Queen Mary University of London. She worked as a Post-doctoral Research Associate at the University of Leicester for six years in the field of Behavioural Neurology before moving into science communication. She worked as the Research Communication Officer at a London based charity for almost two years.