Risk Factors Associated With Mammalian Target of Rapamycin Inhibitor Withdrawal in Kidney Transplant Recipients

Abstract Background Mammalian target of rapamycin inhibitors (mTORi) play an essential role as novel immunosuppressive agents in kidney transplantation (KT). Treatment cessation usually occurs after adverse effects occur. We investigated the risk factors associated with withdrawal of mTORi in KT rec...

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Bibliographic Details
Published in:	Transplantation proceedings Vol. 48; no. 3; pp. 790 - 793
Main Authors:	Lim, L.M, Kung, L.F, Kuo, M.C, Kuo, H.T
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-04-2016
Subjects:	Adult Creatinine - blood Female Glomerulonephritis - complications Humans Immunosuppressive Agents - therapeutic use Kidney Transplantation Male Middle Aged Proteinuria - complications Retrospective Studies Risk Factors Surgery TOR Serine-Threonine Kinases - antagonists & inhibitors
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Summary:	Abstract Background Mammalian target of rapamycin inhibitors (mTORi) play an essential role as novel immunosuppressive agents in kidney transplantation (KT). Treatment cessation usually occurs after adverse effects occur. We investigated the risk factors associated with withdrawal of mTORi in KT recipients and evaluated the outcomes related to the withdrawal. Methods The study enrolled KT recipients being followed up in a medical center in southern Taiwan from January 1999 through December 2014. Results Risk factors associated with mTORi withdrawal were initial proteinuria level, higher initial serum creatinine level posttransplantation, and history of glomerulonephritis as the primary etiology of renal failure. mTORi withdrawal was associated with increased risk of graft failure (hazard ratio [HR], 9.97 [95% confidence interval (CI), 1.03–96.8]; P = .047). Higher body mass index (HR, 11.2 [95% CI, 1.63–76.6]; P = .01) and tacrolimus usage (HR, 8.30 [95% CI, 1.14–60.7]; P = .037) were associated with increased risk of new-onset diabetes after transplantation in mTORi withdrawal groups. Conclusions Proteinuria, poor graft function, and primary glomerulonephritis were associated with cessation of mTORi treatment. Earlier identification of these risk factors may prevent further adverse events and optimize transplantation outcomes after mTORi conversion.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Undefined-1 ObjectType-Feature-3 content type line 23
ISSN:	0041-1345 1873-2623
DOI:	10.1016/j.transproceed.2015.12.085