Center for Transplantation Sciences, Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Saint Louis University Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO.
Semin Nephrol. 2021 Jan;41(1):42-53. doi: 10.1016/j.semnephrol.2021.02.005.
The United States has faced an unprecedented opioid crisis in recent years, which has led to an increase in opioid overdose-related deaths and, consequently, an increase in the number of potential deceased donors available for transplantation. This new pool of potential organ donors is composed of younger donors with higher infectious disease transmission risk. The use of organs from these donors requires appropriate patient education, informed consent, and post-transplant monitoring practices. Prescription opioid use is also an important component of the evaluation of transplant and living donor candidates because it may impact outcomes and eligibility for the procedures. In kidney transplant recipients, prescription opioid use predicts a higher risk of mortality, graft loss, and post-transplant complications. These effects seem to be proportional to the levels of opioid use, and to parallel patterns in other transplant populations such as liver, heart and lung recipients. Among living kidney donors, predonation prescription opioid use is associated with an increased risk of re-admission after nephrectomy. Overall, the opioid epidemic creates educational needs for patients awaiting deceased donor transplant, and also impacts the evaluation and care of transplant candidates. Among transplant candidates and recipients, the identification of patients with chronic opioid use should prompt multidisciplinary evaluation and management strategies to minimize risks.
近年来，美国一直面临着前所未有的阿片类药物危机，这导致了阿片类药物过量相关死亡人数的增加，进而增加了可用于移植的潜在死亡供体数量。这个新的潜在器官供体群体由具有更高传染病传播风险的年轻供体组成。这些供体器官的使用需要适当的患者教育、知情同意和移植后监测措施。处方类阿片类药物的使用也是评估移植和活体供体候选人的一个重要组成部分，因为它可能会影响手术的结果和资格。在肾移植受者中，处方类阿片类药物的使用预示着更高的死亡率、移植物丢失和移植后并发症的风险。这些影响似乎与阿片类药物使用的水平成正比，并与其他移植人群（如肝、心脏和肺受者）的模式相平行。在活体肾供体中，术前使用处方类阿片类药物与肾切除术后再次入院的风险增加相关。总的来说，阿片类药物流行给等待接受已故供体移植的患者带来了教育需求，也影响了移植候选人的评估和护理。在移植候选人和受者中，识别出慢性使用阿片类药物的患者应促使采取多学科评估和管理策略，以最大程度地降低风险。
