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Posttransplant Diabetes Mellitus and Immunosuppression Selection in Older and Obese Kidney Recipients

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 kidne...

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Autores principales: Axelrod, David A., Cheungpasitporn, Wisit, Bunnapradist, Suphamai, Schnitzler, Mark A., Xiao, Huiling, McAdams-DeMarco, Mara, Caliskan, Yasar, Bae, Sunjae, Ahn, JiYoon B., Segev, Dorry L., Lam, Ngan N., Hess, Gregory P., Lentine, Krista L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8767140/
https://www.ncbi.nlm.nih.gov/pubmed/35072042
http://dx.doi.org/10.1016/j.xkme.2021.08.012
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author Axelrod, David A.
Cheungpasitporn, Wisit
Bunnapradist, Suphamai
Schnitzler, Mark A.
Xiao, Huiling
McAdams-DeMarco, Mara
Caliskan, Yasar
Bae, Sunjae
Ahn, JiYoon B.
Segev, Dorry L.
Lam, Ngan N.
Hess, Gregory P.
Lentine, Krista L.
author_facet Axelrod, David A.
Cheungpasitporn, Wisit
Bunnapradist, Suphamai
Schnitzler, Mark A.
Xiao, Huiling
McAdams-DeMarco, Mara
Caliskan, Yasar
Bae, Sunjae
Ahn, JiYoon B.
Segev, Dorry L.
Lam, Ngan N.
Hess, Gregory P.
Lentine, Krista L.
author_sort Axelrod, David A.
collection PubMed
description 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/m(2) vs BMI < 30 kg/m(2): 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/m(2): aHR, 0.69 (95% CI, 0.60-0.78); BMI ≥ 30 kg/m(2): 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/m(2) (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.
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spelling pubmed-87671402022-01-21 Posttransplant Diabetes Mellitus and Immunosuppression Selection in Older and Obese Kidney Recipients Axelrod, David A. Cheungpasitporn, Wisit Bunnapradist, Suphamai Schnitzler, Mark A. Xiao, Huiling McAdams-DeMarco, Mara Caliskan, Yasar Bae, Sunjae Ahn, JiYoon B. Segev, Dorry L. Lam, Ngan N. Hess, Gregory P. Lentine, Krista L. Kidney Med Original Research 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/m(2) vs BMI < 30 kg/m(2): 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/m(2): aHR, 0.69 (95% CI, 0.60-0.78); BMI ≥ 30 kg/m(2): 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/m(2) (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. Elsevier 2021-10-22 /pmc/articles/PMC8767140/ /pubmed/35072042 http://dx.doi.org/10.1016/j.xkme.2021.08.012 Text en © 2021 Published by Elsevier Inc. on behalf of the National Kidney Foundation, Inc. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Research
Axelrod, David A.
Cheungpasitporn, Wisit
Bunnapradist, Suphamai
Schnitzler, Mark A.
Xiao, Huiling
McAdams-DeMarco, Mara
Caliskan, Yasar
Bae, Sunjae
Ahn, JiYoon B.
Segev, Dorry L.
Lam, Ngan N.
Hess, Gregory P.
Lentine, Krista L.
Posttransplant Diabetes Mellitus and Immunosuppression Selection in Older and Obese Kidney Recipients
title Posttransplant Diabetes Mellitus and Immunosuppression Selection in Older and Obese Kidney Recipients
title_full Posttransplant Diabetes Mellitus and Immunosuppression Selection in Older and Obese Kidney Recipients
title_fullStr Posttransplant Diabetes Mellitus and Immunosuppression Selection in Older and Obese Kidney Recipients
title_full_unstemmed Posttransplant Diabetes Mellitus and Immunosuppression Selection in Older and Obese Kidney Recipients
title_short Posttransplant Diabetes Mellitus and Immunosuppression Selection in Older and Obese Kidney Recipients
title_sort posttransplant diabetes mellitus and immunosuppression selection in older and obese kidney recipients
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8767140/
https://www.ncbi.nlm.nih.gov/pubmed/35072042
http://dx.doi.org/10.1016/j.xkme.2021.08.012
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