Novel approaches to understanding pre-transplant medications use and post-transplant health outcomes in renal transplant recipients

• Main Author: Philipneri, Marie
• Format: Dissertation
• Language: English
• Published: ProQuest Dissertations & Theses 01-01-2015
• Subjects: Health care management; Public health
• ISBN: 1339423472; 9781339423470

Advanced chronic kidney disease care is complex and expensive. On average, the patients receiving dialysis are prescribed eleven medications and many are costly. Although kidney transplant recipients are known to have superior health outcomes compared to those remaining on dialysis, there is wide variation in practice patterns and clinical outcomes. In the United States, pre-transplant care at dialysis centers is distinct from post-transplant care at transplant centers. Therefore, traditional methods of evaluations such as single-center or multi-center studies and even large single registry data analysis would be a challenge and may not yield optimal findings. For this research, a novel linked database that integrates national transplant registry data with pharmacy claims data were examined. Adoption rates of renal medications post-Medicare Part D implementation and post-transplant outcomes were evaluated. Medicare Part D Plan was particularly helpful for African American patients who are middle-aged, and those without college education. The patients who had cinacalcet prescription fills prior to renal transplant, had lower patient survival rates 3 years post-renal transplantation. There were no significant differences in outcomes in relation to dose and timing of cinacalcet administration. The patients who had selective serotonin reuptake inhibitors (SSRI) fills prior to renal transplant, had lower patient survival and higher rate of allograft loss, 3 years post-transplant. The patients who used SSRI within 90 days of transplant had lower survival rates compared to those who used SSRI at least 90 days prior to transplant or never used SSRI. It is important to emphasize that association of pre-transplant cinacalcet and SSRI pharmacy fills with post-transplant outcomes do not equate causation. Some of the observed prognostic relations may reflect medical and nonmedical variables that are coupled with medications fills and outcomes. Even though adjustments were made for demographic and clinical attributes, additional clinical information including laboratory data and measures of compliance were unavailable. Future studies are needed to further explore the association between pre-transplant medications use and post-transplant outcomes. These findings could help policy makers direct optimal pre-transplant medical management strategies and focus their efforts on special populations in the implementation of new health care reforms.