Open AccessDifferential risks for adverse outcomes 3 years after kidney transplantation based on initial immunosuppression regimen: a national study
Author(s) -
Dharnidharka Vikas R.,
Schnitzler Mark A.,
Chen Jiajing,
Brennan Daniel C.,
Axelrod David,
Segev Dorry L.,
Schechtman Kenneth B.,
Zheng Jie,
Lentine Krista L.
Publication year - 2016
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/tri.12850
Subject(s) - medicine , thymoglobulin , immunosuppression , hazard ratio , tacrolimus , kidney transplantation , odds ratio , regimen , diabetes mellitus , sepsis , transplantation , gastroenterology , confidence interval , endocrinology
Summary 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 ( IS x) 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 IS x regimen. Compared with the reference IS x (thymoglobulin induction with tacrolimus, mycophenolate, and prednisone maintenance), sirolimus‐based IS x 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 IS x 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 IS x over time warrant further study to better guide IS x tailoring to balance the efficacy and morbidity.