肝移植前使用阿片类药物与移植后死亡风险增加相关。
Opioid use prior to liver transplant is associated with increased risk of death after transplant.
机构信息
Department of Surgery, University of California, San Francisco, San Francisco, CA, USA.
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
出版信息
Am J Surg. 2021 Jul;222(1):234-240. doi: 10.1016/j.amjsurg.2020.11.039. Epub 2020 Nov 20.
BACKGROUND
Opioids are generally discouraged and used sparingly in liver transplant (LT) candidates prior to LT. This study examined the relationship between opioid use at the time of LT and graft and patient survival following transplantation.
METHODS
A retrospective single center cohort study of LT recipients from June 2012 to December 2019 was performed. Primary outcomes were graft and patient survival, analyzed with the Kaplan-Meier method and Cox proportional hazards models; primary predictor was active opioid prescription at LT.
RESULTS
751 LT recipients were included; 16% had an opioid prescription at LT. Post-transplant death was significantly greater in opioid users (pvalue<0.001). In a multivariable Cox model examining predictors of death, opioid use remained associated with a significant increase in the risk of death (HR 2.4 CI 1.5-4.0, p < 0.001) even after controlling for other factors.
CONCLUSION
Opioid use at LT is associated with a markedly increased risk of death following transplant.
背景
在进行肝移植 (LT) 之前，一般不鼓励 LT 候选者使用阿片类药物，并应谨慎使用。本研究检查了 LT 时使用阿片类药物与移植后移植物和患者存活的关系。
方法
对 2012 年 6 月至 2019 年 12 月期间进行的 LT 受者的回顾性单中心队列研究进行了评估。主要结局是移植物和患者存活率，采用 Kaplan-Meier 方法和 Cox 比例风险模型进行分析；主要预测指标是 LT 时的阿片类药物处方是否有效。
结果
共纳入 751 例 LT 受者；16%的患者在 LT 时有阿片类药物处方。阿片类药物使用者的移植后死亡显著更高（p 值<0.001）。在多变量 Cox 模型中，检查死亡的预测因素，即使在控制其他因素后，阿片类药物的使用仍与死亡风险显著增加相关（HR 2.4 CI 1.5-4.0，p<0.001）。
结论
LT 时使用阿片类药物与移植后死亡风险显著增加相关。
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