Impact of Preoperative Opioid Use in Lung Transplant Recipients: A Retrospective Study

Purpose The impact of preoperative opioids on lung transplant outcomes has not been well established. This study explores survival rates and mortality risk factors in lung transplant recipients with preoperative opioid prescriptions. Methods A single-institutional lung transplant database (2018-2024) was used to collect data on patient characteristics, pretransplant laboratory values, and postoperative outcomes. Opioid prescriptions were normalized to morphine equivalents (MEs). Chi-squared, one-way ANOVA, Kruskal-Wallis, Kaplan-Meier, and Wilcoxon signed-rank tests were used for analysis. Results Among 399 lung transplant recipients, 188 (47.1%) reported opioid use within 30 days before transplantation: 115 (61.2%) had ME ≥ 0.1 mg (high-ME), and 73 (38.8%) had ME < 0.1 mg (low-ME). There was no significant difference in one-year survival between the high-ME cohort and their counterparts (83.8% vs. 86.7% (low-ME) vs. 90.5% (no ME), p = 0.86). Intensive care unit (ICU) stay (median: 10 (5-20, interquartile range (IQR)) vs. 7 (5-13, IQR, low-ME) vs. 7 (4-14, IQR, no ME) days, p = 0.046) and hospital stay (median: 21 (13-38, IQR) vs. 17 (11-31, IQR, low-ME) vs. 16 (11-27, IQR, no ME) days, p = 0.007) were significantly longer in the high-ME cohort. The high-ME cohort had a higher incidence of primary graft dysfunction (PGD) (hazard ratio, or HR 1.84 (1.17-2.89, 95% CI), p = 0.008) and PGD Grade 3 (HR 2.16 (1.18-3.97, 95% CI), p = 0.01). Conclusions Preoperative opioid use in lung transplant patients is an independent risk factor for post-transplant PGD risk and a predictor of prolonged hospital stay. Weaning of opioids prior to lung transplantation may limit prolonged hospital stay and ventilation use.