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Observational Study
. 2023 Oct 27;24(1):320.
doi: 10.1186/s12882-023-03325-9.

Determinants of immunosuppressive therapy in renal transplant recipients: an Italian observational study (the CESIT project)

Alessandro C Rosa  1 , Marco Finocchietti  1 , Nera Agabiti  1 , Paolo Menè  2 , Maria Elena Bracaccia  2 , Arianna Bellini  1 , Marco Massari  3 , Stefania Spila Alegiani  3 , Lucia Masiero  4 , Gaia Bedeschi  4 , Massimo Cardillo  4 , Ersilia Lucenteforte  5 , Giuseppe Piccolo  6 , Olivia Leoni  7 , Eliana Ferroni  8 , Silvia Pierobon  8 , Maurizio Nordio  8 , Stefano Ledda  9 , Donatella Garau  9 , Marina Davoli  1 , Antonio Addis  1 , Valeria Belleudi  10 ; CESIT study group
Collaborators, Affiliations
Observational Study

Determinants of immunosuppressive therapy in renal transplant recipients: an Italian observational study (the CESIT project)

Alessandro C Rosa et al. BMC Nephrol. .

Abstract

Background: Very scanty evidence is available on factors influencing the choice of immunosuppressive drug therapy after kidney transplantation.

Methods: An Italian multiregional real-world study was conducted integrating national transplant information system and claims data. All patients undergoing kidney transplantation for the first time during 2009-2019 (incident patients) were considered. Multilevel logistic models were used to estimate Odds Ratio (OR) and corresponding 95% Confidence intervals. Factors with statistically significance were identified as characteristics associated with treatment regimens: cyclosporin-CsA vs tacrolimus-Tac and, within the latter group, mTOR inhibitors vs mycophenolate-MMF.

Results: We identified 3,622 kidney patients undergoing transplantation in 17 hospitals located in 4 Italian regions, 78.3% was treated with TAC-based therapy, of which 78% and 22% in combination with MMF and mTOR, respectively. For both comparison groups, the choice of immunosuppressive regimens was mostly guided by standard hospital practices. Only few recipient and donor characteristics were found associated with specific regimen (donor/receipt age, immunological risk and diabetes).

Conclusions: The choice of post-renal transplant immunosuppressive therapy seems to be mostly driven by standard Centre practices, while only partially based on patient's characteristics and recognized international guidelines.

Keywords: Determinants; Immunosuppressive therapy; Kidney; Real world evidence; Spatio-temporal variability.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Therapeutic regimens in the maintenance phase. Note: In the grey box are the therapeutic classes of immunosuppressive drugs, in clear boxes the actual agents prescribed. Links represent possible concomitant use of drugs
Fig. 2
Fig. 2
Immunosoppressive treatment patterns and comparison groups among kidney transplant patients. Note: The comparison groups are highlighted with more intense colouring
Fig. 3
Fig. 3
Heterogeneity of treatment patterns between transplant centers
Fig. 4
Fig. 4
a Determinants related to index therapy: CsA vs TAC. b Determinants related to index therapy: Tac + mTORi vs TAC + MMF
See this image and copyright information in PMC

References

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