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B93 - Increasing Doses of Pain Medications Pre-Heart Transplant as a Risk Factor for Outcomes after Transplant

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Author Block: K. Shah, D. H. Chang, J. Patel, R. J. Levine, S. Dimbil, E. Passano, J. A. Kobashigawa, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA
*Purpose: Chronic pain syndromes prior to heart transplantation (HTx) are not uncommon. However, the use of morphine equivalents in higher doses may be indicative of certain personality traits. It has been demonstrated in kidney transplant (KTx) patients that the use of high doses of pain medications results in less optimal outcome post-KTx. It is not known whether this risk also applies to HTx candidates. Therefore, we sought to answer this question.
*Methods: Between 2010 and 2017, we assessed 228 HTx candidates on pain medications for the 6-months prior to HTx and adjusted the dosages to morphine equivalents (ME) per day. Patients were divided into the following groups: 1-10 ME/day (n=67), 11-20 ME/day (n=65), and 21+ ME/day (n=96). Post-heart transplant first-year endpoints included: % non-compliance (described as missed clinic appointments), freedom from any treated rejection (ATR), acute cellular rejection (ACR) and antibody-mediated rejection (AMR). Other endpoints included 3-year survival, freedom from CAV (as defined by stenosis greater 30% by angiography), freedom from non-fatal major adverse cardiac events (NF-MACE: myocardial infarction, new congestive heart failure, percutaneous coronary intervention, implantable cardioverter defibrillator/pacemaker implant, stroke). These results were compared to a control group with no opiate use 6-months prior to HTx (n=357).
*Results: Patients who were on high doses of morphine equivalents had similar 1 and 3-year post-transplant outcomes when compared to patients on low doses of morphine and the control group. However, high-dose opioid users were significantly more likely to have more missed clinic appointments (see table).
The use of pain medications prior to HTx should be considered when evaluating potential heart transplant candidates. Patients who use high doses of opiates are of greater risk for non-compliance post-transplant.