TY - JOUR
T1 - Induction immunosuppression agents as risk factors for incident cardiovascular events and mortality after kidney transplantation
AU - Sandal, Shaifali
AU - Bae, Sunjae
AU - McAdams-DeMarco, Mara
AU - Massie, Allan B.
AU - Lentine, Krista L.
AU - Cantarovich, Marcelo
AU - Segev, Dorry L.
N1 - Funding Information:
The data reported herein have been supplied by the United States Renal Data System (USRDS). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy or interpretation of the U.S. government. This study was supported by the National Institutes of Health (NIH) K24DK101828 (Segev). Shaifali Sandal was supported by an educational grant from Amgen to the nephrology division at the McGill University Health Centre and a bursary from the Société Québécoise De Transplantation. Mara McAdams‐DeMarco was supported by K01AG043501 and R01AG055781 from the National Institute on Aging.
Funding Information:
The data reported herein have been supplied by the United States Renal Data System (USRDS). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy or interpretation of the U.S. government. This study was supported by the National Institutes of Health (NIH) K24DK101828 (Segev). Shaifali Sandal was supported by an educational grant from Amgen to the nephrology division at the McGill University Health Centre and a bursary from the Soci?t? Qu?b?coise De Transplantation. Mara McAdams-DeMarco was supported by K01AG043501 and R01AG055781 from the National Institute on Aging.
Publisher Copyright:
© 2018 The American Society of Transplantation and the American Society of Transplant Surgeons
PY - 2019/4
Y1 - 2019/4
N2 - Low T cell counts and acute rejection are associated with increased cardiovascular events (CVEs); T cell–depleting agents decrease both. Thus, we aimed to characterize the risk of CVEs by using an induction agent used in kidney transplant recipients. We conducted a secondary data analysis of patients who received a kidney transplant and used Medicare as their primary insurance from 1999 to 2010. Outcomes of interest were incident CVE, all-cause mortality, CVE-related mortality, and a composite outcome of mortality and CVE. Of 47 258 recipients, 29.3% received IL-2 receptor antagonist (IL-2RA), 33.3% received anti-thymocyte globulin (ATG), 7.3% received alemtuzumab, and 30.0% received no induction. Compared with IL-2RA, there was no difference in the risk of CVE in the ATG (adjusted hazard ratio [aHR] 0.98, 95% confidence interval [CI] 0.92-1.05) and alemtuzumab group (aHR 1.01, 95% CI 0.89-1.16), but slightly higher in the no induction group (aHR 1.06, 95% CI 1.00-1.14). Acute rejection did not modify this association in the latter group but did increase CVE by 46% in the alemtuzumab group. There was no difference in the hazard of all-cause or CVE-related mortality. Only in the ATG group, a 7% lower hazard of the composite outcome of mortality and CVE was noted. Induction agents are not associated with incident CVE, although prospective trials are needed to determine a personalized approach to prevention.
AB - Low T cell counts and acute rejection are associated with increased cardiovascular events (CVEs); T cell–depleting agents decrease both. Thus, we aimed to characterize the risk of CVEs by using an induction agent used in kidney transplant recipients. We conducted a secondary data analysis of patients who received a kidney transplant and used Medicare as their primary insurance from 1999 to 2010. Outcomes of interest were incident CVE, all-cause mortality, CVE-related mortality, and a composite outcome of mortality and CVE. Of 47 258 recipients, 29.3% received IL-2 receptor antagonist (IL-2RA), 33.3% received anti-thymocyte globulin (ATG), 7.3% received alemtuzumab, and 30.0% received no induction. Compared with IL-2RA, there was no difference in the risk of CVE in the ATG (adjusted hazard ratio [aHR] 0.98, 95% confidence interval [CI] 0.92-1.05) and alemtuzumab group (aHR 1.01, 95% CI 0.89-1.16), but slightly higher in the no induction group (aHR 1.06, 95% CI 1.00-1.14). Acute rejection did not modify this association in the latter group but did increase CVE by 46% in the alemtuzumab group. There was no difference in the hazard of all-cause or CVE-related mortality. Only in the ATG group, a 7% lower hazard of the composite outcome of mortality and CVE was noted. Induction agents are not associated with incident CVE, although prospective trials are needed to determine a personalized approach to prevention.
KW - alemtuzumab
KW - basiliximab/daclizumab
KW - cardiovascular disease
KW - clinical research/practice
KW - coronary artery disease
KW - graft survival
KW - health services and outcomes research
KW - immunosuppressant - fusion proteins and monoclonal antibodies
KW - immunosuppression/immune modulation
KW - kidney transplantation/nephrology
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UR - http://www.scopus.com/inward/citedby.url?scp=85058037774&partnerID=8YFLogxK
U2 - 10.1111/ajt.15148
DO - 10.1111/ajt.15148
M3 - Article
C2 - 30372596
AN - SCOPUS:85058037774
SN - 1600-6135
VL - 19
SP - 1150
EP - 1159
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 4
ER -