Evidence map›Paper›PMID 33123009›Full record

ArticleFrontiers in pharmacology2020

Sixteen-Year Cohort of Liver Transplantation in the National Health System in Brazil: Analysis of Immunosuppression Maintenance Therapies.

Guilherme Fagundes Nascimento, Rosângela Maria Gomes, Juliana Alvares-Teodoro, Nélio Gomes Ribeiro, Mariângela Leal Cherchiglia, Charles Simão-Filho, Francisco Assis Acurcio, Tulio Tadeu Rocha Sarmento, Ludmila Peres Gargano, Augusto Afonso Guerra

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Article in Frontiers in pharmacology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

What it found

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2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

10 authors.

Guilherme Fagundes NascimentoDepartment of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Rosângela Maria GomesDepartment of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Juliana Alvares-TeodoroDepartment of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Nélio Gomes RibeiroSUS Collaborating Centre-Technology Assessment & Excellence in Health, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Mariângela Leal CherchigliaDepartment of Preventive and Social Medicine, College of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Charles Simão-FilhoDepartment of Surgery, College of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Francisco Assis AcurcioDepartment of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Tulio Tadeu Rocha SarmentoSUS Collaborating Centre-Technology Assessment & Excellence in Health, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Ludmila Peres GarganoSUS Collaborating Centre-Technology Assessment & Excellence in Health, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Augusto Afonso GuerraDepartment of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo evaluate factors related to liver graft survival with a focus on immunosuppressive schemes based on calcineurin inhibitors (tacrolimus or cyclosporine). METHODOLOGY: This study was carried out through an open cohort constructed by deterministic and probabilistic matching through three databases of the SUS with assessment of liver graft survival from 2000 to 2015 in Brazil. From this first cohort, a second cohort was constructed by pairing 1: 1 to more precisely assess the effect of the immunosuppressive scheme on graft survival. The Kaplan-Meier method and was used to estimate the probability of survival. Cox's model of proportional risks was used to assess factors related to graft loss.

resultWe found 12,687 patients in the Full cohort and 470 patients in the Matched cohort. The overall graft survival rates at 1, 5, 10, and 16 years were 72.6, 63.3, 52.8, and 45.3%, respectively. Patients younger had a longer graft survival than older ones. In the Full cohort, male patients had a higher survival rate than female ones. Therapeutic schemes based on tacrolimus were more prevalent and had a better survival rate when compared to schemes that used cyclosporine. Tacrolimus without association with antiproliferative agents or rapamycin inhibitors was the therapeutic scheme associated with greater survival rate in both cohorts (HR = 0.81, 95% CI = 0.72-0.91), (HR = 0.50, 95% CI = 0.30-0.85). In addition, white-skinned patients had longer survival rate in both cohorts (HR = 0.55, 95% CI = 0.50-0.61 and HR = 0.50, 95% CI = 0.34-0.75). On the other hand, patients who a greater time ratio without using an immunosuppressant had lower graft survival rate (HR = 6.46, 95% CI = 5.05-8.27 and HR = 6.57, 95% CI = 2.66-16.22).

conclusionThis 16-year cohort showed that the older age and the greater time ratio without using an immunosuppressant are risk factors for liver graft loss. White-skinned patients and tacrolimus-based regimens, especially tacrolimus without other immunosuppressants, are factors of better prognosis to the graft.

Indexed as

calcineurin inhibitorcyclosporinegraft survivalimmunosuppressionliver transplantationNational Health Servicesurvival analysistacrolimus

Identifiers

PMID33123009
PMCPMC7573511

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