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https://hdl.handle.net/2440/9944
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Type: | Journal article |
Title: | Associations between use of cyclosporine-sparing agents and outcome in kidney transplant recipients |
Author: | McDonald, S. Russ, G. |
Citation: | Kidney International, 2002; 61(6):2259-2265 |
Publisher: | Blackwell Science Inc |
Issue Date: | 2002 |
ISSN: | 0085-2538 1523-1755 |
Abstract: | <h4>Background</h4>Diltiazem, widely used as a cyclosporine-sparing agent, has been suggested to confer a benefit on graft and patient outcome in kidney transplantation related to immunomodulatory properties. Use of cyclosporine-sparing agents (CsSpA) is routinely recorded by the Australia & New Zealand Dialysis and Transplant (ANZDATA) Registry, and we used these data to examine the associations between CsSpA use and outcomes.<h4>Methods</h4>Graft and patient survival were analyzed for a cohort of 3913 people who received kidney transplants in Australia or New Zealand between 1 April 1993 and 30 March 2001. Patients were followed to death or loss of graft function. Graft and patient survival analyses were performed using Cox proportional hazards models, including a time varying covariate for CsSpA use in analyses of graft failure. Occurrence of delayed graft function (DGF) and acute rejection also were examined as secondary outcomes.<h4>Results</h4>There was no difference in patient survival in the first 12 months post transplantation, but from 12 months onwards there is a survival advantage associated with CsSpA use among cadaveric donor (CD) recipients in both univariate hazard ratio (HR) 0.56, 95% CI 0.41 to 0.76, P < 0.001 and multivariate (HR 0.56, 95% CI 0.40 to 0.79, P < 0.001) analyses. This was consistent across subgroups examined. Lower rates of early graft loss (censored for death) were associated with CsSpA use [odds ratio (OR) 0.61, 95% CI 0.50 to 0.75, P < 0.0001]. Lower rates of use of antibody therapy for rejection also were observed, but not lower rates of biopsy-proven rejection.<h4>Conclusions</h4>CsSpA use was associated with improved patient mortality after kidney transplantation. Whether this was a direct drug effect or due to other factors associated with diltiazem use cannot be inferred directly from these data, although several plausible mechanisms exist which might mediate a diltiazem effect. |
Keywords: | Kidney Humans Diltiazem Cyclosporine Immunosuppressive Agents Adjuvants, Immunologic Treatment Outcome Kidney Transplantation Registries Incidence Proportional Hazards Models Survival Analysis Cohort Studies Graft Rejection Graft Survival Dose-Response Relationship, Drug Time Factors |
DOI: | 10.1046/j.1523-1755.2002.00386.x |
Published version: | http://dx.doi.org/10.1046/j.1523-1755.2002.00386.x |
Appears in Collections: | Aurora harvest Medicine publications |
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