Long‐term outcomes in African American kidney transplant recipients under contemporary immunosuppression: a four‐yr analysis of the Mycophenolic acid Observational REnal transplant (MORE) study

Narayanan, Mohanram; Pankewycz, O.; Shihab, Fuad S.; Wiland, Anne; McCague, Kevin; Chan, Laurence

doi:10.1111/ctr.12294

Cited by 21 publications

(15 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…First transplant outcomes analysis shows that this is not due to lesser rates of first and second transplant graft failure in African-American patients, in fact they suggest higher graft loss if any(11, 20, 21). African-American patients were more highly sensitized and had fewer living donor transplants, which could make it more difficult to get a 3KT.…”

Section: Discussionmentioning

confidence: 94%

Graft and Patient Survival Outcomes of a Third Kidney Transplant

Redfield

Gupta²,

Rodríguez³

et al. 2015

Transplantation

View full text Add to dashboard Cite

Background The waiting time for deceased donor renal transplantation in the United States continues to grow. Retransplant candidates make up a small but growing percentage of the overall transplant waiting list and raise questions about the stewardship of scarce resources. The utility of renal transplantation among individuals with two prior renal transplants is not described in the literature and we thus sought to determine the survival benefit associated with a third kidney transplant (3KT). Methods Multivariable Cox regression models were created to determine characteristics associated with 3KT outcomes and the survival benefit of 3KT among recipients wait listed and transplanted within the United States between 1995 and 2009. Results 4,334 patients were waitlisted for a 3KT and 2,492 patients received a 3KT. In a multivariate analysis, 3KT demonstrated an overall patient survival benefit compared to the wait list (HR-0.379, CI=0.302-0.475 p<0.001) for those awaiting their first, second or third kidney transplants, although an inferior graft outcome compared to first kidney transplants. The time to survival benefit did not accrue until 8-months after transplant. Additionally we found that the duration of second graft survival was predictive of third graft survival, such that second graft survival beyond 5 years is associated with superior 3KT graft survival. Second graft loss in 30 days or less was not associated with inferior 3KT graft survival. Conclusion 3KT achieves a survival benefit over remaining on the wait list, although is associated with inferior graft outcomes compared to first kidney transplants. Graft survival of the second transplant beyond 5 years is associated with superior 3KT graft survival.

show abstract

Section: Discussionmentioning

confidence: 94%

Graft and Patient Survival Outcomes of a Third Kidney Transplant

Redfield

Gupta²,

Rodríguez³

et al. 2015

Transplantation

View full text Add to dashboard Cite

show abstract

“…Disparities in clinical outcomes following kidney transplantation among patient subgroups have long been reported . African‐American race is associated with a higher risk for acute rejection and graft loss; some data suggest an increased risk for graft loss and mortality in older kidney transplant recipients and females have been shown to have a greater risk for mortality following kidney transplantation than men . The reason for disparities in clinical outcomes is multifactorial and includes both immunological (e.g., biology, immunity, genetics, metabolism, pharmacology) and nonimmunological factors (e.g., comorbidities; time on dialysis; donor, organ, and recipient characteristics; socioeconomic status, medication adherence, access to care) .…”

Section: Introductionmentioning

confidence: 99%

LCPTonce‐daily extended‐release tacrolimus tablets versus twice‐daily capsules: a pooled analysis of two phase 3 trials in importantde novoand stable kidney transplant recipient subgroups

Bunnapradist

Rostaing²,

Alloway

et al. 2016

Transpl Int

View full text Add to dashboard Cite

SUMMARYAfrican-American and elderly kidney transplant recipients (KTR) have increased risk for poor clinical outcomes post-transplant. Management of immunosuppression may be challenging in these patients and contribute to worse outcomes. A novel once-daily formulation of tacrolimus (LCPT) has demonstrated noninferiority, similar safety, improved bioavailability, a consistent concentration time profile, and less peak and peak-trough fluctuations vs. tacrolimus twice-daily (Tac BID). This pooled analysis of two phase 3 randomized, controlled trials, including 861 (LCPT N = 428; Tac BID N = 433; 38% of patients were stable KTR, and 62% were de novo KTR) patients, examined the efficacy of LCPT in KTR subgroups (blacks, females, and age ≥65). Overall, treatment failure [death, graft failure, centrally read biopsy-proven acute rejection (BPAR), or lost to follow-up] at 12 months was as follows: LCPT: 11.9%, BID Tac: 13.4% [À1.48% (À5.95%, 2.99%)]. BPAR rates were as follows: LCPT: 8.2%, Tac BID: 9.5% [À1.29% (À5.14%, 2.55%)]. Numerically, fewer treatment failure events with LCPT were found in the majority of subgroups, with significantly less treatment failure associated with LCPT among black KTR [À13.82% (À27.22%, À0.31%)] and KTR ≥65 [À13.46% (À25.27%, À0.78%)]. This pooled analysis suggests numerically lower efficacy failure rates associated with LCPT among high-risk subgroups, in particular black KTR and KTR ≥65 years old.

show abstract

“…Donor-associated covariates included donor type (living or deceased), age, race height, weight, diabetes mellitus status, hypertension, hepatitis C virus status, and cold ischemia time (13). Recipient-associated covariates included age, ethnicity, gender, dialysis vintage time, diabetes mellitus status, and percent panel reactive antibody (14-16). Transplant-related covariates included induction immunosuppression (characterized as lymphodepleting, nonlymphodepleting [basiliximab and daclizumab], steroids, or none), and maintenance immunosuppression (mycophenolate mofetil versus azathioprine and steroids versus “steroid free”).…”

Section: Methodsmentioning

confidence: 99%

Belatacept Compared With Tacrolimus for Kidney Transplantation

et al. 2017

View full text Add to dashboard Cite

Background While tacrolimus is the basis of most maintenance immunosuppression regimens for kidney transplantation, concerns about toxicity have made alternative agents, such as belatacept, attractive to clinicians. However, limited data exists to directly compare outcomes with belatacept-based regimens to tacrolimus. Methods We performed a propensity score matched cohort study of adult kidney transplant recipients transplanted between May 1, 2001 and December 31, 2015 using national transplant registry data to compare patient and allograft survival in patients discharged from their index hospitalization on belatacept versus tacrolimus-based regimens. Results In the primary analysis, we found that belatacept was not associated with a statistically significant difference in risk of patient death (HR 0.84, 95% CI 0.61-1.15, p=0.28) or allograft loss (HR 0.83, 95% CI 0.62-1.11, p=0.20) despite an increased risk of acute rejection in the first year posttransplant (OR 3.12, 95% CI 2.13-4.57, p<0.001). These findings were confirmed in additional sensitivity analyses that accounted for use of belatacept in combination with tacrolimus, transplant center effects, and differing approaches to matching. Conclusions Belatacept appears to have similar longitudinal risk of mortality and allograft failure compared to tacrolimus-based regimens. These data are encouraging but require confirmation in prospective randomized controlled trials.

show abstract

Long‐term outcomes in African American kidney transplant recipients under contemporary immunosuppression: a four‐yr analysis of the Mycophenolic acid Observational REnal transplant (MORE) study

Cited by 21 publications

References 26 publications

Graft and Patient Survival Outcomes of a Third Kidney Transplant

Graft and Patient Survival Outcomes of a Third Kidney Transplant

LCPTonce‐daily extended‐release tacrolimus tablets versus twice‐daily capsules: a pooled analysis of two phase 3 trials in importantde novoand stable kidney transplant recipient subgroups

Belatacept Compared With Tacrolimus for Kidney Transplantation

Contact Info

Product

Resources

About