Logo image
Back
Differential risks for adverse outcomes 3 years after kidney transplantation based on initial immunosuppression regimen: a national study
Journal article   Open access   Peer reviewed

Differential risks for adverse outcomes 3 years after kidney transplantation based on initial immunosuppression regimen: a national study

Vikas R Dharnidharka, Mark A Schnitzler, Jiajing Chen, Daniel C Brennan, David Axelrod, Dorry L Segev, Kenneth B Schechtman, Jie Zheng and Krista L Lentine
Transplant international, Vol.29(11), pp.1226-1236
11/2016
DOI: 10.1111/tri.12850
PMCID: PMC5114846
PMID: 27564782
url
https://www.ncbi.nlm.nih.gov/pmc/articles/5114846View
Open Access

Abstract

We examined integrated national transplant registry, pharmacy fill, and medical claims data for Medicare-insured kidney transplant recipients in 2000-2011 (n = 45 164) from the United States Renal Data System to assess the efficacy and safety endpoints associated with seven early (first 90 days) immunosuppression (ISx) regimens. Risks of clinical complications over 3 years according to IS regimens were assessed with multivariate regression analysis, including the adjustment for covariates and propensity for receipt of a nonreference ISx regimen. Compared with the reference ISx (thymoglobulin induction with tacrolimus, mycophenolate, and prednisone maintenance), sirolimus-based ISx was associated with significantly higher three-year risks of pneumonia (adjusted hazard ratio, aHR 1.45; P < 0.0001), sepsis (aHR 1.40; P < 0.0001), diabetes (aHR 1.21; P < 0.0001), acute rejection (AR; adjusted odds ratio, aOR 1.33; P < 0.0001), graft failure (aHR 1.78; P < 0.0001), and patient death (aHR 1.40; P < 0.0001), but reduced skin cancer risk (aHR 0.71; P < 0.001). Cyclosporine-based IS was associated with increased risks of pneumonia (aHR 1.17; P < 0.001), sepsis (aHR 1.16; P < 0.001), AR (aOR 1.43; P < 0.001), and graft failure (aHR 1.39; P < 0.001), but less diabetes (aHR 0.83; P < 0.001). Steroid-free ISx was associated with the reduced risk of pneumonia (aHR 0.89; P = 0.002), sepsis (aHR 0.80; P < 0.001), and diabetes (aHR 0.77; P < 0.001), but higher graft failure (aHR 1.35; P < 0.001). Impacts of ISx over time warrant further study to better guide ISx tailoring to balance the efficacy and morbidity.
 Immunosuppression United States Adolescent Adult Cyclosporine - therapeutic use Diabetes Mellitus - diagnosis Female Humans Immunosuppressive Agents - therapeutic use Kidney Transplantation Male Middle Aged Multivariate Analysis Mycophenolic Acid - therapeutic use Pneumonia - diagnosis Renal Insufficiency - surgery Risk Sepsis - diagnosis Sirolimus - therapeutic use Tacrolimus - therapeutic use Young Adult

Details

Metrics

18 Record Views
42 Times Cited - Web of Science
Logo image