Metformin Use in the First Year after Kidney Transplant, Correlates and Associated Outcomes in Diabetic Transplant Recipients: A Retrospective Analysis of Integrated Registry and Pharmacy Claims Data

Ls Vest; Fm Koraishy; Z Zhang; Nn Lam; Ma Schnitzler; Vr Dharnidharka; D Axelrod; As Naik; Ta Alhamad; Bl Kasiske; Gp Hess; Kl Lentine

doi:10.1111/ctr.13302

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Metformin Use in the First Year after Kidney Transplant, Correlates and Associated Outcomes in Diabetic Transplant Recipients: A Retrospective Analysis of Integrated Registry and Pharmacy Claims Data

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Metformin Use in the First Year after Kidney Transplant, Correlates and Associated Outcomes in Diabetic Transplant Recipients: A Retrospective Analysis of Integrated Registry and Pharmacy Claims Data

Ls Vest, Fm Koraishy, Z Zhang, Nn Lam, Ma Schnitzler, Vr Dharnidharka, D Axelrod, As Naik, Ta Alhamad, Bl Kasiske, …

Clinical transplantation, Vol.32(8), pp.e13302-n/a

06/29/2018

DOI: 10.1111/ctr.13302

PMCID: PMC6122956

PMID: 29851159

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Abstract

While guidelines support metformin as a therapeutic option for diabetic patients with mild-to-moderate renal insufficiency, the frequency and outcomes of metformin use in kidney transplant recipients are not well described. We integrated national U.S. transplant registry data with records from a large pharmaceutical claims clearinghouse (2008–2015). Associations (adjusted hazard ratio, (95% LCL)aHR(95% UCL)) of diabetes regimens (with and excluding metformin) in the first year post-transplant with patient and graft survival over the subsequent year were quantified by multivariate Cox regression, adjusted for recipient, donor, and transplant factors and propensity for metformin use. Among 14,144 recipients with pretransplant type 2 diabetes mellitus, 4.7% filled metformin in the first year posttransplant; most also received diabetes comedications. Compared to those who received insulin-based regimens without metformin, patients who received metformin were more likely to be female, have higher estimated glomerular filtration rates, and been transplanted more recently. Metformin-based regimens were associated with significantly lower adjusted all-cause (aHR (0.18)0.41(0.91)), malignancy-related (aHR (0.45)0.45(0.99)), and infection-related (aHR (0.12)0.32(0.85)) mortality, and non-significant trends toward lower cardiovascular mortality, graft failure and acute rejection. No evidence of increased adverse graft or patient outcomes was noted. Use of metformin-based diabetes treatment regimens may be safe in carefully selected kidney transplant recipients.

endocrine system diseases

nutritional and metabolic diseases

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Title: Subtitle: Metformin Use in the First Year after Kidney Transplant, Correlates and Associated Outcomes in Diabetic Transplant Recipients: A Retrospective Analysis of Integrated Registry and Pharmacy Claims Data
Creators: Ls Vest
Fm Koraishy
Z Zhang
Nn Lam
Ma Schnitzler
Vr Dharnidharka
D Axelrod
As Naik
Ta Alhamad
Bl Kasiske
Gp Hess
Kl Lentine
Resource Type: Journal article
Publication Details: Clinical transplantation, Vol.32(8), pp.e13302-n/a
DOI: 10.1111/ctr.13302
PMID: 29851159
PMCID: PMC6122956
NLM abbreviation: Clin Transplant
ISSN: 0902-0063
eISSN: 1399-0012
Grant note: This work was supported by a grant from the National Institutes of Health (NIH)/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) R01DK102981.
Language: English
Date published: 06/29/2018
Academic Unit: Surgery
Record Identifier: 9984051734902771

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