Journal article
Induction immunosuppression and the risk of incident malignancies among older and younger kidney transplant recipients: A prospective cohort study
Clinical transplantation, v 34(12), 14121
Dec 2020
PMID: 33048385
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Background: Older (>= 65) KT recipients differ from their younger counterparts in their immune response to immunosuppression (IS) and may have a different risk of malignancy after receiving induction.
Methods: We identified 66 700 adult KT recipients treated with anti-thymocyte globulin (ATG) (n = 40 443) or interleukin-2 receptor antagonist (IL-2RA) (n = 26 327) induction (1/1/1999-12/31/2014) using USRDS/Medicare data. We estimated the risk of first-diagnosed post-KT malignancy associated with induction (ATG vs. IL-2RA) using Cox proportional hazard models. We then tested whether these risks differed between older and younger recipients (Wald test for interaction). Models incorporated inverse probability of treatment weights to adjust for confounders.
Results: The 3-year cumulative incidences of any diagnosed malignancy were 11.5%. ATG was associated with a higher malignancy risk (HR = 1.12, 95%CI:1.06-1.18). This association differed (p(interaction) = 0.04) between younger (HR = 1.12, 95%CI:1.06-1.18) and older recipients (HR = 1.03, 95%CI:0.96-1.09). ATG was also associated with higher risk of skin (HR = 1.18, 95%CI:1.08-1.29), lung (HR = 1.24, 95%CI:1.05-1.47), and ovary malignancies (HR = 1.94, 95%CI:1.08-3.48). However, only the association of ATG with post-KT skin malignancy differed (p(interaction) = 0.01) between younger (HR = 1.18; 95%CI:1.08-1.29) and older (HR = 1.01; 95%CI:0.93-1.09) recipients.
Conclusions: Compared with IL-2RA induction, ATG was associated with elevated post-KT malignancy risk but only among younger recipients. Transplant centers may need to tailor induction IS for younger recipients to mitigate malignancy risk.
Metrics
Details
- Title
- Induction immunosuppression and the risk of incident malignancies among older and younger kidney transplant recipients: A prospective cohort study
- Creators
- Lingyu Wang - Johns Hopkins UniversityJennifer Motter - Johns Hopkins Univ, Sch Med, Dept Surg, Baltimore, MD 21205 USASunjae Bae - Johns Hopkins MedicineJiYoon B. Ahn - Johns Hopkins UniversityJennifer A. Kanakry - National Institutes of HealthJohn Jackson - Johns Hopkins UniversityMark A. Schnitzler - Saint Louis UniversityGregory Hess - Drexel Univ, Sch Med, Philadelphia, PA 19104 USAKrista L. Lentine - St Louis Univ, Ctr Abdominal Transplantat, St Louis, MO 63103 USAElizabeth A. Stuart - Johns Hopkins UniversityDorry L. Segev - New York UniversityMara McAdams-DeMarco - Johns Hopkins University
- Publication Details
- Clinical transplantation, v 34(12), 14121
- Publisher
- Wiley
- Number of pages
- 11
- Grant note
- K24DK101828; R01DK114074 / National Institute of Diabetes and Digestive and Kidney Diseases; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK) R01AG055781 / National Institute on Aging; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute on Aging (NIA)
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- College of Medicine
- Web of Science ID
- WOS:000590694400001
- Scopus ID
- 2-s2.0-85096652830
- Other Identifier
- 991021860672704721
UN Sustainable Development Goals (SDGs)
This publication has contributed to the advancement of the following goals:
Source: SDGs in the Output
InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Surgery
- Transplantation