Journal article
Posttransplant Diabetes Mellitus and Immunosuppression Selection in Older and Obese Kidney Recipients
Kidney medicine, Vol.4(1), pp.100377-100377
01/2022
DOI: 10.1016/j.xkme.2021.08.012
PMCID: PMC8767140
PMID: 35072042
Abstract
Posttransplant diabetes mellitus (DM) after kidney transplantation increases morbidity and mortality, particularly in older and obese recipients. We aimed to examine the impact of immunosuppression selection on the risk of posttransplant DM among both older and obese kidney transplant recipients.
Retrospective database study.
Kidney-only transplant recipients aged ≥18 years from 2005 to 2016 in the United States from US Renal Data System records, which integrate Organ Procurement and Transplantation Network/United Network for Organ Sharing records with Medicare billing claims.
Various immunosuppression regimens in the first 3 months after transplant.
Development of DM >3 months-to-1 year posttransplant.
We used multivariable Cox regression to compare the incidence of posttransplant DM by immunosuppression regimen with the reference regimen of thymoglobulin (TMG) or alemtuzumab (ALEM) with tacrolimus + mycophenolic acid + prednisone using inverse propensity weighting.
12.7% of kidney transplant recipients developed posttransplant DM with higher incidences in older (≥55 years vs <55 years: 16.7% vs 10.1%) and obese (body mass index [BMI] ≥ 30 kg/m2 vs BMI < 30 kg/m2: 17.1% vs 10.9%) patients. The incidence of posttransplant DM was lower with steroid avoidance [TMG/ALEM + no prednisone (8.4%) and IL2rAb + no prednisone (9.7%)] than TMG/ALEM with triple therapy (13.1%). After adjustment for donor and recipient characteristics, TMG/ALEM with steroid avoidance was beneficial for all groups [age < 55 years: adjusted HR (aHR), 0.63 (95% confidence interval [CI], 0.54-0.72); age ≥ 55 years: aHR, 0.69 (95% CI, 0.60-0.79); BMI < 30 kg/m2: aHR, 0.69 (95% CI, 0.60-0.78); BMI ≥ 30 kg/m2: aHR, 0.67 (95% CI, 0.57-0.79)]. However, IL2rAb with steroid avoidance was beneficial only for older patients (aHR, 0.76; 95% CI, 0.58-0.99) and for those with BMI < 30 kg/m2 (aHR, 0.63; 95% CI, 0.46-0.87).
Retrospective study and lacked data on immunosuppression levels.
The beneficial impact of steroid avoidance using tacrolimus on posttransplant DM appears to differ by patient age and induction regimen.
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Details
- Title: Subtitle
- Posttransplant Diabetes Mellitus and Immunosuppression Selection in Older and Obese Kidney Recipients
- Creators
- David A. Axelrod - University of IowaWisit Cheungpasitporn - Mayo ClinicSuphamai Bunnapradist - University of California, Los AngelesMark A. Schnitzler - Saint Louis UniversityHuiling Xiao - Saint Louis UniversityMara McAdams-DeMarco - Johns Hopkins UniversityYasar Caliskan - Saint Louis UniversitySunjae Bae - Johns Hopkins UniversityJiYoon B. Ahn - Johns Hopkins School of Medicine, Baltimore, MarylandDorry L. Segev - Johns Hopkins UniversityNgan N. Lam - University of CalgaryGregory P. Hess - Drexel UniversityKrista L. Lentine - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Kidney medicine, Vol.4(1), pp.100377-100377
- DOI
- 10.1016/j.xkme.2021.08.012
- PMID
- 35072042
- PMCID
- PMC8767140
- NLM abbreviation
- Kidney Med
- ISSN
- 2590-0595
- eISSN
- 2590-0595
- Publisher
- Elsevier Inc
- Grant note
- DOI: 10.13039/100015015, name: Government of South Australia; DOI: 10.13039/100016477, name: CareDx; DOI: 10.13039/100000062, name: National Institute of Diabetes and Digestive and Kidney Diseases, award: R01DK120518
- Language
- English
- Date published
- 01/2022
- Academic Unit
- Surgery
- Record Identifier
- 9984322796602771
Metrics
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