Evidence map›Paper›PMID 42318931›Full record

SynthesisTransplantation2026

Impact of Intrapatient Immunosuppression Variability in Renal Transplantation Outcomes: A Systematic Review and Meta-analysis.

Sherene Lattimore, Anastasia Chambers, Isabella Angeli-Pahim, Abhishek Shrestha, Benjamin O Eke, Ariel Pomputius, Carma L Bylund, Megan E Gregory, Ali Zarrinpar

Abstract readSystematic ReviewMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Transplantation, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Sherene LattimoreDepartment of Surgery, University of Florida, Gainesville, FL.
Anastasia ChambersDepartment of Surgery, University of Florida, Gainesville, FL.
Isabella Angeli-PahimDepartment of Surgery, University of Florida, Gainesville, FL.
Abhishek ShresthaDepartment of Surgery, University of Florida, Gainesville, FL.
Benjamin O EkeDepartment of Surgery, University of Florida, Gainesville, FL.
Ariel PomputiusUniversity of Florida, Gainesville, FL.
Carma L BylundDepartment of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL.
Megan E GregoryDepartment of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL.
Ali ZarrinparDepartment of Surgery, Division of Transplantation and Hepatobiliary Surgery, University of Florida, Gainesville, FL.

Funding

Novel pathways in the pathogenesis and pathophysiology of NAFLD in HispanicsR01MD012579 · NIMHD · OHIO UNIVERSITY ATHENS · PI FRIEDMAN, THEODORE C, NAJJAR, SONIA M. · 2019 to 2023
$3.2M
Diversity Supplement: Directing Tryptophan Immunometabolism to Ameliorate Liver Ischemic-Reperfusion InjuryR01DK129690 · NIDDK · UNIVERSITY OF FLORIDA · PI KESELOWSKY, BENJAMIN GEORGE, ZARRINPAR, ALI · 2022 to 2025
$2.7M
Mentoring Patient-Oriented Research in Immune Response in TransplantationK24AI187634 · NIAID · UNIVERSITY OF FLORIDA · PI ALI ZARRINPAR · 2025 to 2026
$251k
NIAID NIH HHS K24 AI187634NIDDK NIH HHS R01 DK129690NIMHD NIH HHS R01 MD012579
6 · The paper itself

Abstract

backgroundIntrapatient variability (IPV) is the changes of a drug's blood trough concentration in a patient. There is a lack of consensus on whether high IPV is associated with poor outcomes in transplantation.

methodsSeveral electronic databases, including MEDLINE/PubMed, Embase, Web of Science, Cochrane Reviews, and the Cochrane CENTRAL Register of Controlled Trials, served as sources for the literature search. Covidence facilitated the sorting and extraction of data. The meta-analysis was conducted using R Studio.

resultsAbout 5210 studies were identified in initial database searches, with 41 articles ultimately included in this review. We reviewed outcomes, including acute rejection, chronic rejection, allograft survival, patient survival, and development of de novo donor-specific antibodies (dnDSA). Numerous papers supported the conjecture high IPV was associated with increased rejection rates and worse allograft survival rates, while for patient survival, chronic rejection, and dnDSA development results were equivocal regarding the effect of IPV. Meta-analysis showed that patients with low IPV had a 44% lower risk of acute rejection compared with patients with high IPV (RR = 0.56). Patients with high IPV had an increased risk of graft loss, HR = 2.42 (95% CI, 1.70-3.46).

conclusionsOur analysis showed that acute rejection and allograft survival are impacted by high IPV. In conclusion, this study establishes high IPV as a significant modifiable risk factor for acute rejection and graft loss, warranting its integration into routine clinical monitoring.

Indexed as

Graft RejectionGraft SurvivalImmunosuppressive AgentsKidney TransplantationHumansIsoantibodiesRisk FactorsTreatment OutcomeImmunosuppressive AgentsIsoantibodies

Identifiers

PMID42318931
PMCPMC13418061

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.