ArticleTransplantation2021
Immunosuppression Regimen Use and Outcomes in Older and Younger Adult Kidney Transplant Recipients: A National Registry Analysis.
Article in Transplantation, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 1 of them a synthesis that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
20 citing papers in PubMed, 1 synthesis or guideline pooled it, 37 citations in OpenAlex.
- Thai Transplant Care Practice Guideline on Immunosuppressive Therapy for Adult Kidney Transplantation.Nephrology (Carlton, Vic.) · 2026Guideline
- Do BKPyV genomic features underlie clinical divergence between kidney and hematopoietic transplant recipients?Virulence · 2026Article
- Outcomes Following Alemtuzumab Induction in Deceased Donor Kidney Transplantation According to Recipient Age Categories: A Single Center Report.Clinical transplantation · 2026Article
- Reappraisal of Risk Factors for T-Cell-Mediated Kidney Rejection.Kidney international reports · 2026Article
- Eligibility, timing, and organ quality: indications and outcomes of kidney transplantation in older patients.Kidney international · 2026Review
- Carcinogenic Medications: A Review of Specific Agents and Molecular Mechanisms of Carcinogenesis.Cancer reports (Hoboken, N.J.) · 2026Review
- Age-specific impact of different immunosuppressive regimens on kidney transplant outcomes: clinical evidence from the scientific registry of transplant recipients.Frontiers in nephrology · 2026Article
- DNA methylation predicts infection risk in kidney transplant recipients.Life science alliance · 2025Article
- High Mortality and Associated Risk Factors in Kidney Transplant Recipients With Cryptococcosis-A Nationwide Cohort Study Over a Decade Using USRDS Data.Open forum infectious diseases · 2025Article
- Early Steroid Withdrawal in Kidney Transplant Recipients: PRO.Kidney360 · 2025Article
- Gut Microbial Dysbiosis and Implications in Solid Organ Transplantation.Biomedicines · 2024Review
- Kidney transplants from elderly donors: what we have learned 20 years after the Crystal City consensus criteria meeting.Journal of nephrology · 2024Review
- A Drug Safety Concept (I) to Avoid Polypharmacy Risks in Transplantation by Individual Pharmacotherapy Management in Therapeutic Drug Monitoring of Immunosuppressants.Pharmaceutics · 2023Article
- Distinct phenotypes of kidney transplant recipients aged 80 years or older in the USA by machine learning consensus clustering.BMJ surgery, interventions, & health technologies · 2023Article
- Baseline Characteristics and Representativeness of Participants in the BEST-Fluids Trial: A Randomized Trial of Balanced Crystalloid Solution Versus Saline in Deceased Donor Kidney Transplantation.Transplantation direct · 2022Article
- Kidney Transplantation, Immunosuppression and the Risk of Fracture: Clinical and Economic Implications.Kidney medicine · 2022Article
- Progress and Recent Advances in Solid Organ Transplantation.Journal of clinical medicine · 2022Article
- Posttransplant Diabetes Mellitus and Immunosuppression Selection in Older and Obese Kidney Recipients.Kidney medicine · 2022Article
- Outcomes of Kidney Transplant Recipients with Sickle Cell Disease: An Analysis of the 2000-2019 UNOS/OPTN Database.Journal of clinical medicine · 2021Article
- Immunosuppression Considerations for Older Kidney Transplant Recipients.Current transplantation reports · 2021Article
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Authors and funding
14 authors at 7 institutions in 2 countries.
Funding
Abstract
backgroundAlthough the population of older transplant recipients has increased dramatically, there are limited data describing the impact of immunosuppression regimen choice on outcomes in this recipient group.
methodsNational data for US Medicare-insured adult kidney recipients (N = 67 362; 2005-2016) were examined to determine early immunosuppression regimen and associations with acute rejection, death-censored graft failure, and mortality using multivariable regression analysis in younger (18-64 y) and older (>65 y) adults.
resultsThe use of antithymocyte globulin (TMG) or alemtuzumab (ALEM) induction with triple maintenance immunosuppression (reference) was less common in older compared with younger (36.9% versus 47.0%) recipients, as was TMG/ALEM + steroid avoidance (19.2% versus 20.1%) and mammalian target of rapamycin inhibitor (mTORi)-based (6.7% versus 7.7%) treatments. Conversely, older patients were more likely to receive interleukin (IL)-2-receptor antibody (IL2rAb) + triple maintenance (21.1% versus 14.7%), IL2rAb + steroid avoidance (4.1% versus 1.8%), and cyclosporine-based (8.3% versus 6.6%) immunosuppression. Compared with older recipients treated with TMG/ALEM + triple maintenance (reference regimen), those managed with TMG/ALEM + steroid avoidance (adjusted odds ratio [aOR], 0.440.520.61) and IL2rAb + steroid avoidance (aOR, 0.390.550.79) had lower risk of acute rejection. Older patients experienced more death-censored graft failure when managed with Tac + antimetabolite avoidance (adjusted hazard [aHR], 1.411.782.25), mTORi-based (aHR, 1.702.142.71), and cyclosporine-based (aHR, 1.411.782.25) regimens, versus the reference regimen. mTORi-based and cyclosporine-based regimens were associated with increased mortality in both older and younger patients.
conclusionsLower-intensity immunosuppression regimens (eg, steroid-sparing) appear beneficial for older kidney transplant recipients, while mTORi and cyclosporine-based maintenance immunosuppression are associated with higher risk of adverse outcomes.
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