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Induction Immunosuppression and Renal Outcomes in Adult Heart Transplantation.
- Source :
-
The Journal of surgical research [J Surg Res] 2021 Mar; Vol. 259, pp. 14-23. Date of Electronic Publication: 2020 Dec 02. - Publication Year :
- 2021
-
Abstract
- 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.<br />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.<br />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).<br />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.<br /> (Copyright © 2020. Published by Elsevier Inc.)
- Subjects :
- Adult
Aged
Confounding Factors, Epidemiologic
Female
Glomerular Filtration Rate physiology
Graft Rejection immunology
Graft Rejection prevention & control
Heart Failure complications
Heart Failure mortality
Humans
Immunosuppression Therapy methods
Immunosuppression Therapy standards
Immunosuppression Therapy statistics & numerical data
Male
Middle Aged
Postoperative Complications etiology
Postoperative Complications physiopathology
Postoperative Complications therapy
Practice Guidelines as Topic
Practice Patterns, Physicians' standards
Preoperative Period
Renal Dialysis statistics & numerical data
Renal Insufficiency etiology
Renal Insufficiency physiopathology
Renal Insufficiency therapy
Retrospective Studies
Risk Factors
Young Adult
Heart Failure surgery
Heart Transplantation adverse effects
Immunosuppression Therapy adverse effects
Postoperative Complications epidemiology
Practice Patterns, Physicians' statistics & numerical data
Renal Insufficiency epidemiology
Subjects
Details
- Language :
- English
- ISSN :
- 1095-8673
- Volume :
- 259
- Database :
- MEDLINE
- Journal :
- The Journal of surgical research
- Publication Type :
- Academic Journal
- Accession number :
- 33278793
- Full Text :
- https://doi.org/10.1016/j.jss.2020.11.021