Induction immunosuppression agents as risk factors for incident cardiovascular events and mortality after kidney transplantation

Abstract

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.

Tumor Necrosis Factor Directs Allograft-Related Innate Responses and Its Neutralization Improves Hepatocyte Engraftment in Rats

“…2 Remarkably, gene expression profiling indicates that acute and chronic rejection share similarities in activation of IFN-g, TNF-a, or other cytokines, chemokines, and receptors. 2,3 To control lymphocyte-dependent allograft rejection, therapeutic targets include ILs (eg, IL-2, -4, -6, -12/ 23, and -15) 1,4 and chemokines, 5 whereas controlling innate responses needs additional strategies. 6 Transplanting allogeneic cells or tissues is highly significant for liver-directed therapies.…”

Risk factors for global longitudinal strain impairment in renal transplant recipients with preserved left ventricular ejection fraction

“…Impaired GLS in CKD patients is an indicator of decreased LV contractility probably due to LV remodelling with increased accumulation of extracellular matrix and myocardial fibrosis. Recently, Sandal et al found that congestive heart failure, but not the coronary artery disease, is the most common cause of cardiovascular events following KTx [9]. That finding confirms earlier outcomes of studies based on the United States Renal Data System conducted on thousands of patient [10].…”

Prolonged haemodialysis increases the risk of the impairment of global longitudinal strain in patient after kidney transplantation and a preserved ejection fraction of left ventricle

“…Impaired GLS in CKD patients is an indicator of decreased LV contractility probably due to LV remodelling with increased accumulation of extracellular matrix and myocardial fibrosis. Recently, Sandal et al found that congestive heart failure, but not coronary artery disease, is the most common cause of cardiovascular events following KTx [11]. That finding confirms earlier outcomes of studies based on the United States Renal Data System conducted on thousands of patient [12].…”