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Determinants of immunosuppressive therapy in renal transplant recipients: an Italian observational study (the CESIT project)

BACKGROUND: Very scanty evidence is available on factors influencing the choice of immunosuppressive drug therapy after kidney transplantation. METHODS: An Italian multiregional real-world study was conducted integrating national transplant information system and claims data. All patients undergoing...

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Autores principales: Rosa, Alessandro C., Finocchietti, Marco, Agabiti, Nera, Menè, Paolo, Bracaccia, Maria Elena, Bellini, Arianna, Massari, Marco, Spila Alegiani, Stefania, Masiero, Lucia, Bedeschi, Gaia, Cardillo, Massimo, Lucenteforte, Ersilia, Piccolo, Giuseppe, Leoni, Olivia, Ferroni, Eliana, Pierobon, Silvia, Nordio, Maurizio, Ledda, Stefano, Garau, Donatella, Davoli, Marina, Addis, Antonio, Belleudi, Valeria
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10604923/
https://www.ncbi.nlm.nih.gov/pubmed/37891504
http://dx.doi.org/10.1186/s12882-023-03325-9
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author Rosa, Alessandro C.
Finocchietti, Marco
Agabiti, Nera
Menè, Paolo
Bracaccia, Maria Elena
Bellini, Arianna
Massari, Marco
Spila Alegiani, Stefania
Masiero, Lucia
Bedeschi, Gaia
Cardillo, Massimo
Lucenteforte, Ersilia
Piccolo, Giuseppe
Leoni, Olivia
Ferroni, Eliana
Pierobon, Silvia
Nordio, Maurizio
Ledda, Stefano
Garau, Donatella
Davoli, Marina
Addis, Antonio
Belleudi, Valeria
author_facet Rosa, Alessandro C.
Finocchietti, Marco
Agabiti, Nera
Menè, Paolo
Bracaccia, Maria Elena
Bellini, Arianna
Massari, Marco
Spila Alegiani, Stefania
Masiero, Lucia
Bedeschi, Gaia
Cardillo, Massimo
Lucenteforte, Ersilia
Piccolo, Giuseppe
Leoni, Olivia
Ferroni, Eliana
Pierobon, Silvia
Nordio, Maurizio
Ledda, Stefano
Garau, Donatella
Davoli, Marina
Addis, Antonio
Belleudi, Valeria
author_sort Rosa, Alessandro C.
collection PubMed
description BACKGROUND: Very scanty evidence is available on factors influencing the choice of immunosuppressive drug therapy after kidney transplantation. METHODS: An Italian multiregional real-world study was conducted integrating national transplant information system and claims data. All patients undergoing kidney transplantation for the first time during 2009–2019 (incident patients) were considered. Multilevel logistic models were used to estimate Odds Ratio (OR) and corresponding 95% Confidence intervals. Factors with statistically significance were identified as characteristics associated with treatment regimens: cyclosporin-CsA vs tacrolimus-Tac and, within the latter group, mTOR inhibitors vs mycophenolate-MMF. RESULTS: We identified 3,622 kidney patients undergoing transplantation in 17 hospitals located in 4 Italian regions, 78.3% was treated with TAC-based therapy, of which 78% and 22% in combination with MMF and mTOR, respectively. For both comparison groups, the choice of immunosuppressive regimens was mostly guided by standard hospital practices. Only few recipient and donor characteristics were found associated with specific regimen (donor/receipt age, immunological risk and diabetes). CONCLUSIONS: The choice of post-renal transplant immunosuppressive therapy seems to be mostly driven by standard Centre practices, while only partially based on patient’s characteristics and recognized international guidelines. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12882-023-03325-9.
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spelling pubmed-106049232023-10-28 Determinants of immunosuppressive therapy in renal transplant recipients: an Italian observational study (the CESIT project) Rosa, Alessandro C. Finocchietti, Marco Agabiti, Nera Menè, Paolo Bracaccia, Maria Elena Bellini, Arianna Massari, Marco Spila Alegiani, Stefania Masiero, Lucia Bedeschi, Gaia Cardillo, Massimo Lucenteforte, Ersilia Piccolo, Giuseppe Leoni, Olivia Ferroni, Eliana Pierobon, Silvia Nordio, Maurizio Ledda, Stefano Garau, Donatella Davoli, Marina Addis, Antonio Belleudi, Valeria BMC Nephrol Research BACKGROUND: Very scanty evidence is available on factors influencing the choice of immunosuppressive drug therapy after kidney transplantation. METHODS: An Italian multiregional real-world study was conducted integrating national transplant information system and claims data. All patients undergoing kidney transplantation for the first time during 2009–2019 (incident patients) were considered. Multilevel logistic models were used to estimate Odds Ratio (OR) and corresponding 95% Confidence intervals. Factors with statistically significance were identified as characteristics associated with treatment regimens: cyclosporin-CsA vs tacrolimus-Tac and, within the latter group, mTOR inhibitors vs mycophenolate-MMF. RESULTS: We identified 3,622 kidney patients undergoing transplantation in 17 hospitals located in 4 Italian regions, 78.3% was treated with TAC-based therapy, of which 78% and 22% in combination with MMF and mTOR, respectively. For both comparison groups, the choice of immunosuppressive regimens was mostly guided by standard hospital practices. Only few recipient and donor characteristics were found associated with specific regimen (donor/receipt age, immunological risk and diabetes). CONCLUSIONS: The choice of post-renal transplant immunosuppressive therapy seems to be mostly driven by standard Centre practices, while only partially based on patient’s characteristics and recognized international guidelines. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12882-023-03325-9. BioMed Central 2023-10-27 /pmc/articles/PMC10604923/ /pubmed/37891504 http://dx.doi.org/10.1186/s12882-023-03325-9 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Rosa, Alessandro C.
Finocchietti, Marco
Agabiti, Nera
Menè, Paolo
Bracaccia, Maria Elena
Bellini, Arianna
Massari, Marco
Spila Alegiani, Stefania
Masiero, Lucia
Bedeschi, Gaia
Cardillo, Massimo
Lucenteforte, Ersilia
Piccolo, Giuseppe
Leoni, Olivia
Ferroni, Eliana
Pierobon, Silvia
Nordio, Maurizio
Ledda, Stefano
Garau, Donatella
Davoli, Marina
Addis, Antonio
Belleudi, Valeria
Determinants of immunosuppressive therapy in renal transplant recipients: an Italian observational study (the CESIT project)
title Determinants of immunosuppressive therapy in renal transplant recipients: an Italian observational study (the CESIT project)
title_full Determinants of immunosuppressive therapy in renal transplant recipients: an Italian observational study (the CESIT project)
title_fullStr Determinants of immunosuppressive therapy in renal transplant recipients: an Italian observational study (the CESIT project)
title_full_unstemmed Determinants of immunosuppressive therapy in renal transplant recipients: an Italian observational study (the CESIT project)
title_short Determinants of immunosuppressive therapy in renal transplant recipients: an Italian observational study (the CESIT project)
title_sort determinants of immunosuppressive therapy in renal transplant recipients: an italian observational study (the cesit project)
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10604923/
https://www.ncbi.nlm.nih.gov/pubmed/37891504
http://dx.doi.org/10.1186/s12882-023-03325-9
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