دورية أكاديمية
Immunosuppressant Medication Use in Patients with Kidney Allograft Failure: A Prospective Multicenter Canadian Cohort Study.
| العنوان: | Immunosuppressant Medication Use in Patients with Kidney Allograft Failure: A Prospective Multicenter Canadian Cohort Study. |
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| المؤلفون: | Knoll G; University of Ottawa, Department of Medicine (Nephrology) and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada., Campbell P; Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, Alberta, Canada., Chassé M; Department of Medicine (Critical Care), University of Montreal Hospital, Montreal, Quebec, Canada; University of Montreal Hospital Research Centre, Montreal, Quebec, Canada., Fergusson D; Clinical Epidemiology Program, the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada., Ramsay T; Clinical Epidemiology Program, the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada., Karnabi P; Clinical Epidemiology Program, the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada., Perl J; Division of Nephrology, St. Michael's Hospital, Department of Medicine, University of Toronto, Toronto, Ontario, Canada., House AA; Western University, Department of Medicine (Nephrology) and the London Health Sciences Centre, London, Ontario, Canada., Kim J; Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Division of Nephrology and the Ajmera Transplant Centre, Department of Medicine, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada., Johnston O; University of British Columbia, Division of Nephrology, Vancouver General Hospital, Vancouver, British Columbia, Canada., Mainra R; Saskatchewan Transplant Program, Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada., Houde I; Transplantation Unit, Renal Division, Department of Medicine, University Health Centre of Quebec, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada., Baran D; Division of Nephrology and the Multi-Organ Transplant Program, Royal Victoria Hospital, McGill University Health Centre, Montreal, Quebec, Canada., Treleaven DJ; Division of Nephrology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada., Senecal L; Department of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada., Tibbles LA; Southern Alberta Transplant Program, Department of Medicine, University of Calgary, Calgary, Alberta, Canada., Hébert MJ; University of Montreal Hospital Research Centre and University of Montreal, Montreal, Quebec, Canada; Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada; Department of Medicine, University of Montreal, Montreal, Quebec, Canada., White C; Department of Medicine, Queen's University, Kingston, Ontario, Canada., Karpinski M; Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada., Gill JS; University of British Columbia Division of Nephrology, St. Paul's Hospital, Vancouver, British Columbia, Canada. |
| المصدر: | Journal of the American Society of Nephrology : JASN [J Am Soc Nephrol] 2022 Jun; Vol. 33 (6), pp. 1182-1192. Date of Electronic Publication: 2022 Mar 23. |
| نوع المنشور: | Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't |
| اللغة: | English |
| بيانات الدورية: | Publisher: Wolters Kluwer Health, on behalf of the American Society of Nephrology Country of Publication: United States NLM ID: 9013836 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1533-3450 (Electronic) Linking ISSN: 10466673 NLM ISO Abbreviation: J Am Soc Nephrol Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2023- : Hagerstown, MD : Wolters Kluwer Health, on behalf of the American Society of Nephrology Original Publication: Baltimore, MD : Williams & Wilkins, c1990- |
| مواضيع طبية MeSH: | Kidney Transplantation*/adverse effects , Renal Insufficiency*/etiology, Allografts ; Canada ; Cohort Studies ; Graft Rejection/prevention & control ; Graft Survival ; Humans ; Immunosuppressive Agents/therapeutic use ; Kidney ; Prednisone/therapeutic use ; Prospective Studies |
| مستخلص: | Background: Patients with kidney transplant failure have a high risk of hospitalization and death due to infection. The optimal use of immunosuppressants after transplant failure remains uncertain and clinical practice varies widely. Methods: This prospective cohort study enrolled patients within 21 days of starting dialysis after transplant failure in 16 Canadian centers. Immunosuppressant medication use, death, hospitalized infection, rejection of the failed allograft, and anti-HLA panel reactive antibodies were determined at 1, 3, 6, and 12 months and and then twice yearly until death, repeat transplantation, or loss to follow-up. Results: The 269 study patients were followed for a median of 558 days. There were 33 deaths, 143 patients hospitalized for infection, and 21 rejections. Most patients (65%) continued immunosuppressants, 20% continued prednisone only, and 15% discontinued all immunosuppressants. In multivariable models, patients who continued immunosuppressants had a lower risk of death (hazard ratio [HR], 0.40; 95% confidence interval [CI], 0.17 to 0.93) and were not at increased risk of hospitalized infection (HR, 1.81; 95% CI, 0.82 to 4.0) compared with patients who discontinued all immunosuppressants or continued prednisone only. The mean class I and class II panel reactive antibodies increased from 11% to 27% and from 25% to 47%, respectively, but did not differ by immunosuppressant use. Continuation of immunosuppressants was not protective of rejection of the failed allograft (HR, 0.81; 95% CI, 0.22 to 2.94). Conclusions: Prolonged use of immunosuppressants >1 year after transplant failure was not associated with a higher risk of death or hospitalized infection but was insufficient to prevent higher anti-HLA antibodies or rejection of the failed allograft. (Copyright © 2022 by the American Society of Nephrology.) |
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| معلومات مُعتمدة: | FRN 102732 Canada CIHR |
| فهرسة مساهمة: | Keywords: kidney transplantation; rejection; survival; transplant nephrectomy |
| المشرفين على المادة: | 0 (Immunosuppressive Agents) VB0R961HZT (Prednisone) |
| تواريخ الأحداث: | Date Created: 20220324 Date Completed: 20220602 Latest Revision: 20230602 |
| رمز التحديث: | 20230602 |
| مُعرف محوري في PubMed: | PMC9161795 |
| DOI: | 10.1681/ASN.2021121642 |
| PMID: | 35321940 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 1533-3450 |
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| DOI: | 10.1681/ASN.2021121642 |