Differential risks for adverse outcomes 3 years after kidney transplantation based on initial immunosuppression regimen: a national study.
Differential risks for adverse outcomes 3 years after kidney transplantation based on initial immunosuppression regimen: a national study.
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DOI：
10.1111/tri.12850
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发表时间：
2016-11
期刊：
影响因子：
--
通讯作者：
Lentine KL
中科院分区：
文献类型：
--
作者：
Dharnidharka VR;Schnitzler MA;Chen J;Brennan DC;Axelrod D;Segev DL;Schechtman KB;Zheng J;Lentine KL
We examined integrated national transplant registry, pharmacy fill and medical claims data for Medicare-insured kidney transplant recipients in 2000–2011 (n=45,164) from the United States Renal Data System to assess efficacy and safety endpoints associated with 7 early (first 90 days) immunosuppression (ISx) regimens. Risks of clinical complications over 3 years according to IS regimens were assessed with multivariate regression, including adjustment for covariates and propensity for receipt of a non-reference ISx regimen. Compared to the reference ISx (thymoglobulin induction with tacrolimus, mycophenolate and prednisone maintenance), sirolimus-based ISx was associated with significantly higher 3-year risks of pneumonia (adjusted hazard ratio, aHR 1.45;P<0.0001), sepsis (aHR 1.40;P<0.0001), diabetes (aHR 1.21;P<0.0001), acute rejection (AR; adjusted odds ratio, aOR 1.33;p<0.0001), graft failure (aHR 1.78;p<0.0001), and patient death (aHR 1.40;P<0.0001), but reduced skin cancer risk (aHR 0.71;p<0.001). Cyclosporine-based IS was associated with increased risks of pneumonia (aHR 1.17;p<0.001), sepsis (aHR 1.16;p<0.001), AR (aOR 1.43;p<0.001) and graft failure (aHR 1.39p<0.001), but less diabetes (aHR 0.83;p<0.001). Steroid-free ISx was associated with reduced risk of pneumonia (aHR 0.89;p=0.002), sepsis (aHR 0.80;p<0.001) and diabetes (aHR 0.77;p<0.001) but higher graft failure (aHR 1.35;p<0.001). Impacts of ISx over time warrant further study to better guide ISx tailoring to balance efficacy and morbidity.
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影响因子：
120.7
作者：
Engels, Eric A.;Pfeiffer, Ruth M.;Fraumeni, Joseph F., Jr.;Kasiske, Bertram L.;Israni, Ajay K.;Snyder, Jon J.;Wolfe, Robert A.;Goodrich, Nathan P.;Bayakly, A. Rana;Clarke, Christina A.;Copeland, Glenn;Finch, Jack L.;Fleissner, Mary Lou;Goodman, Marc T.;Kahn, Amy;Koch, Lori;Lynch, Charles F.;Madeleine, Margaret M.;Pawlish, Karen;Rao, Chandrika;Williams, Melanie A.;Castenson, David;Curry, Michael;Parsons, Ruth;Fant, Gregory;Lin, Monica
通讯作者：
Lin, Monica
DOI：
10.2215/cjn.03080707
发表时间：
2008-07-01
影响因子：
9.8
作者：
Lentine, Krista L.;Rey, Lisa A. Rocca;Brennan, Daniel C.
通讯作者：
Brennan, Daniel C.
影响因子：
6.2
作者：
Kauffman, HM;Cherikh, WS;Kahan, BD
通讯作者：
Kahan, BD
影响因子：
158.5
作者：
Ekberg, Henrik;Tedesco-Silva, Helio;Halloran, Philip F.
通讯作者：
Halloran, Philip F.
影响因子：
13.6
作者：
Lentine, KL;Brennan, DC;Schnitzler, MA
通讯作者：
Schnitzler, MA