TY - JOUR
T1 - Posttransplant Diabetes Mellitus and Immunosuppression Selection in Older and Obese Kidney Recipients
AU - Axelrod, David A.
AU - Cheungpasitporn, Wisit
AU - Bunnapradist, Suphamai
AU - Schnitzler, Mark A.
AU - Xiao, Huiling
AU - McAdams-DeMarco, Mara
AU - Caliskan, Yasar
AU - Bae, Sunjae
AU - Ahn, Ji Yoon B.
AU - Segev, Dorry L.
AU - Lam, Ngan N.
AU - Hess, Gregory P.
AU - Lentine, Krista L.
N1 - Funding Information:
This work was funded by a grant from National Institute of Diabetes and Digestive and Kidney Disease (NIDDK) R01DK120518. Dr Lentine is supported by the Mid-America Transplant/Jane A. Beckman Endowed Chair in Transplantation.
Funding Information:
David A. Axelrod, MD, MBA, Wisit Cheungpasitporn, MD, Suphamai Bunnapradist, MD, MS, Mark A. Schnitzler, PhD, Huiling Xiao, MS, Mara McAdams-DeMarco, PhD, Yasar Caliskan, MD, Sunjae Bae, PhD, JiYoon B. Ahn, PhD, Dorry L. Segev, MD, PhD, Ngan N. Lam, MD, Gregory P. Hess, MD, and Krista L. Lentine, MD, PhD, ∗DAA and WC contributed equally to this work. Study design and data interpretation: DAA, WC, KLL, SB, NNL, YC, MAS, MM-D, DLS, SB, JBA, GPH; data acquisition: DAA, MAS, KLL; data analysis: HX. Each author contributed important intellectual content during manuscript drafting or revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved. This work was funded by a grant from National Institute of Diabetes and Digestive and Kidney Disease (NIDDK) R01DK120518. Dr Lentine is supported by the Mid-America Transplant/Jane A. Beckman Endowed Chair in Transplantation. DAA, MAS, and KLL report consulting fees from CareDx. KLL reports speaker honoraria from Sanofi Genzyme. The remaining authors declare that they have no relevant financial interests. The data reported here have been supplied by the United States Renal Data System. The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy or interpretation of the US government. Portions of these findings were presented at the 2021 American Transplant Congress virtual meeting, June 2021. Received May 21, 2021. Evaluated by 2 external peer reviewers, with direct editorial input by the Statistical Editor and the Editor-in-Chief. Accepted in revised form August 30, 2021.
Publisher Copyright:
© 2021
PY - 2022/1
Y1 - 2022/1
N2 - Rationale & Objective: 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. Study Design: Retrospective database study. Setting & Participants: 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. Exposures: Various immunosuppression regimens in the first 3 months after transplant. Outcomes: Development of DM >3 months-to-1 year posttransplant. Analytical Approach: 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. Results: 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). Limitations: Retrospective study and lacked data on immunosuppression levels. Conclusions: The beneficial impact of steroid avoidance using tacrolimus on posttransplant DM appears to differ by patient age and induction regimen.
AB - Rationale & Objective: 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. Study Design: Retrospective database study. Setting & Participants: 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. Exposures: Various immunosuppression regimens in the first 3 months after transplant. Outcomes: Development of DM >3 months-to-1 year posttransplant. Analytical Approach: 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. Results: 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). Limitations: Retrospective study and lacked data on immunosuppression levels. Conclusions: The beneficial impact of steroid avoidance using tacrolimus on posttransplant DM appears to differ by patient age and induction regimen.
KW - Immunosuppression
KW - kidney transplantation
KW - new onset diabetes after transplantation
KW - posttransplant diabetes mellitus
KW - transplantation
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U2 - 10.1016/j.xkme.2021.08.012
DO - 10.1016/j.xkme.2021.08.012
M3 - Article
C2 - 35072042
AN - SCOPUS:85120495699
SN - 2590-0595
VL - 4
JO - Kidney Medicine
JF - Kidney Medicine
IS - 1
M1 - 100377
ER -