Induction Immunosuppression and Renal Outcomes in Adult Heart Transplantation
Autor: | Carlos E. Diaz-Castrillon, Gavin Hickey, Ibrahim Sultan, Lauren V. Huckaby, Arman Kilic |
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Rok vydání: | 2021 |
Předmět: |
Adult
Graft Rejection Male medicine.medical_specialty medicine.medical_treatment Renal function Article Young Adult 03 medical and health sciences Postoperative Complications 0302 clinical medicine Renal Dialysis Risk Factors Interquartile range Diabetes mellitus Internal medicine medicine Humans Renal Insufficiency Renal replacement therapy Practice Patterns Physicians' Dialysis Aged Retrospective Studies Heart Failure Immunosuppression Therapy Heart transplantation business.industry Confounding Factors Epidemiologic Middle Aged medicine.disease Transplantation 030220 oncology & carcinogenesis Practice Guidelines as Topic Preoperative Period Heart Transplantation Female 030211 gastroenterology & hepatology Surgery Outcomes research business Glomerular Filtration Rate |
Zdroj: | J Surg Res |
ISSN: | 0022-4804 |
Popis: | BACKGROUND: This study explores the use of induction therapy in orthotopic heart transplantation as it relates to preoperative renal function and evaluates the impact of its utilization on post-transplant outcomes. METHODS: We conducted a retrospective analysis using the United Network for Organ Sharing database from 2000 to 2018 evaluating the initiation of de novo dialysis after transplantation. We examined the relationship between induction immunosuppression and pre-transplant estimated glomerular filtration rate with post-transplant outcomes, accounting for inter-center variability through a mixed-effects logistic regression model. RESULTS: In total, 16,201 patients were included with a median age of 57 y (interquartile range 47, 63); 26% were women (n = 4222) and 28% (n = 4552) had a history of diabetes mellitus. The median estimated glomerular filtration rate (eGFR) was 67.5 mL/min (interquartile range 53.1, 86.7); 51.2% (n = 3068) of the recipients with eGFR < 60 received induction therapy compared to 42.5% (n = 4336) within the eGFR ≥ 60 group (P < 0.001). Adjusted multivariable analysis found that induction therapy was associated with de novo dialysis (odds ratio 1.25, 95% confidence interval 1.10–1.43, P < 0.001), with the most significant effect on patients with eGFR ≥ 60. Although significant, there was a weak correlation between center-level induction utilization and mean eGFR (r = −0.2, P < 0.001). CONCLUSION: In this analysis, the use of induction immunosuppression in orthotopic heart transplantation varied widely between centers and did not correlate strongly with pre-transplant eGFR. In addition, its utilization did not mitigate the risk of renal replacement therapy after transplantation and in fact was associated with increased risk even after adjusting for confounders most notably in patients with eGFR ≥ 60. |
Databáze: | OpenAIRE |
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