Journal article
Posttransplant Diabetes Mellitus and Immunosuppression Selection in Older and Obese Kidney Recipients
KIDNEY MEDICINE, v 4(1), 100377
Jan 2022
PMID: 35072042
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
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 tocompare 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/m2: 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/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.
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Details
- Title
- Posttransplant Diabetes Mellitus and Immunosuppression Selection in Older and Obese Kidney Recipients
- Publication Details
- KIDNEY MEDICINE, v 4(1), 100377
- Publisher
- ELSEVIER; AMSTERDAM
- Grant note
- 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.
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Drexel University
- Web of Science ID
- WOS:000746505500001
- Scopus ID
- 2-s2.0-85120495699
- Other Identifier
- 991021861303604721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Urology & Nephrology