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, Krista L. Lentine

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)1226-1236
Number of pages11
JournalTransplant International
Volume29
Issue number11
DOIs
StatePublished - Nov 1 2016

Keywords

  • Medicare
  • cancer
  • immunosuppression
  • infections
  • kidney transplant
  • registries

ASJC Scopus subject areas

  • Transplantation

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