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Influence of pretransplant midodrine use on outcomes after kidney transplantation
Author(s) -
Pottebaum April A.,
Hagopian Jennifer C.,
Brennan Daniel C.,
Gharabagi Ara,
Horwedel Timothy A.
Publication year - 2018
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.13366
Subject(s) - medicine , midodrine , kidney transplantation , hazard ratio , transplantation , hemodialysis , panel reactive antibody , dialysis , cohort , proportional hazards model , surgery , confidence interval , basiliximab , prospective cohort study , renal function , blood pressure , orthostatic vital signs
Evaluation of potential kidney transplant recipients is important to identify and treat conditions that may influence graft or patient survival after transplantation. We performed a single‐center, observational cohort study to determine whether pretransplant midodrine use influences outcomes after kidney transplantation. We analyzed graft and patient outcomes for adult patients who underwent a kidney‐only transplantation at Barnes‐Jewish Hospital from January 1999 to December 2015. We quantified adjusted associations of pretransplant midodrine use with post‐transplant complications by multivariable Cox regression. Among the 2621 kidney transplant recipients analyzed, 37 (1.4%) were taking midodrine immediately prior to transplantation. Midodrine users were more commonly older (56.5 vs 50.4 years) and obese (67.6% vs 33.6%). Midodrine users were also more likely to be on hemodialysis (86.5% vs 59.2%), to have a longer duration of dialysis dependence (646 months vs 577 months), and to have higher levels of sensitization (peak panel reactive antibody >20%, 32.4% vs 15.8%) compared to nonusers. Pretransplant midodrine users had significantly higher rates of delayed graft function (DGF) (32.4% vs 6.7%, P < 0.001). No difference in the incidence of DGF was observed based on the midodrine dosing regimen. After multivariable adjustment for recipient and donor characteristics, pretransplant midodrine use was independently associated with graft failure at 1 year (adjusted hazard ratio, 5.11; 95% confidence interval, 2.09‐12.49).