College of Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee, USA,
Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Nephron. 2020;144(7):321-330. doi: 10.1159/000507257. Epub 2020 May 20.
Little is known about the effect of posttransplant opioid use on adherence to immunosuppressant therapy (IST) among adult renal transplant recipients (RTRs).
The aim of this study was to examine the relationship between opioid use and IST adherence among adult RTRs during the first year posttransplant.
Longitudinal data were analyzed from a retrospective cohort study examining US veterans undergoing renal transplant from October 1, 2007, through March 31, 2015. Data were collected from the US Renal Data System, Centers for Medicare and Medicaid Services Data (Medicare Part D), and Veterans Affairs pharmacy records. Dose of opioid prescriptions was collected and divided based on annual morphine milligram equivalent within a year of transplant. Proportion of days covered of greater than or equal to 80% indicated adherence to tacrolimus. Unadjusted and multivariable-adjusted logistic regression analyses were performed.
A study population of 1,229 RTRs included 258 with no opioid use, while 971 opioid users were identified within the first year after transplantation. Compared to RTRs without opioid usage, RTRs with opioid usage had a lower probability of being adherent to tacrolimus in unadjusted logistic regression (odds ratio [OR] (95% confidence interval [CI]): 0.22 [0.07-0.72]) and adjusted logistic regression (OR [95% CI]: 0.11 [0.03-0.44]). These patterns generally remained consistent in unadjusted and adjusted main and sensitivity analyses.
Findings indicate RTRs who use prescription opioids during the first year posttransplant, regardless of the dosage/amount, are less likely to be adherent to tacrolimus. Future studies are needed to better understand underlying causes of the association between opioid use and tacrolimus nonadherence.
对于成年肾移植受者（RTR）在移植后使用阿片类药物对免疫抑制剂治疗（IST）依从性的影响，知之甚少。
本研究旨在探讨成年 RTR 在移植后第一年阿片类药物使用与 IST 依从性之间的关系。
对 2007 年 10 月 1 日至 2015 年 3 月 31 日期间接受肾移植的美国退伍军人进行回顾性队列研究的纵向数据进行了分析。数据来自美国肾脏数据系统、医疗保险和医疗补助服务数据（医疗保险部分 D）和退伍军人事务部药房记录。收集了阿片类药物处方的剂量，并根据移植后一年内每年吗啡毫克当量进行了划分。大于或等于 80%的天数覆盖表示他克莫司的依从性。进行了未调整和多变量调整的逻辑回归分析。
在包括 258 名未使用阿片类药物的 RTR 在内的研究人群中，有 971 名 RTR 在移植后一年内被确定为阿片类药物使用者。与未使用阿片类药物的 RTR 相比，未调整的逻辑回归分析（比值比[OR]（95%置信区间[CI]）：0.22 [0.07-0.72]）和调整后的逻辑回归分析（OR [95% CI]：0.11 [0.03-0.44]）中，阿片类药物使用者更不可能依从他克莫司。这些模式在未调整和调整后的主要和敏感性分析中基本保持一致。
研究结果表明，在移植后第一年使用处方阿片类药物的 RTR，无论剂量/用量多少，依从他克莫司的可能性较低。需要进一步的研究来更好地了解阿片类药物使用与他克莫司不依从之间关联的潜在原因。
