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Profiling risk for acute rejection in kidney transplantation: recipient age is a robust risk factor

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Abstract

Careful management of immunosuppression is paramount to prevent acute rejection in kidney transplantation. We studied a cohort of 139,875 kidney transplant recipients from the Organ Procurement and Transplantation Network (OPTN) database between 2002 and 2013. We confirmed the analysis with a cohort of 35,277 who received thymoglobulin induction with tacrolimus maintenance, and a third cohort of 12,161 recipients who received basiliximab induction with tacrolimus maintenance. We performed multivariate logistic regression analyses on data from all three cohorts and identified independent risk factors for treated acute rejection at 1 year. Recipient age was a robust risk factor for rejection in all three cohorts in a dose response pattern. Young age (18–25 years) was among the strongest risk factors for rejection in all three cohorts; thymoglobulin cohort: OR 1.87 (1.59–2.19); basiliximab cohort: OR 2.41 (1.89–3.05); and inclusive cohort: OR 1.97 (1.83–2.12). The opposite was true for old age (65–69 years); thymoglobulin cohort: OR 0.69 (0.59–0.81); basiliximab cohort: OR 0.77 (0.62–0.96); and inclusive cohort: OR 0.75 (0.70–0.80). This study is unique because it is the largest and most comprehensive multivariate analysis that demonstrates recipient age is a robust risk factor for acute rejection in an inverse dose response pattern.

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Funding

This study required no external funding.

Author information

Authors and Affiliations

  1. Michael E. DeBakey Department of Surgery,Division of Abdominal Transplantation and Division of Hepatobiliary Surgery, Baylor College of Medicine, One Baylor Plaza, MS:BCM390, Houston, TX, 77030, USA

    Abbas Rana, Bhamidipati Murthy, Ronald Cotton, N. Thao N. Galvan, John Goss & Christine O’Mahony

  2. Michael E. DeBakey Department of Surgery, Division of General Surgery, Baylor College of Medicine, Houston, TX, USA

    Zachery Pallister & Michael Kueht

  3. Department of Transplant Nephrology, Baylor St Luke’s Medical Center, Houston, TX, USA

    Whiston Etheridge

  4. Dan Duncan Cancer Center, Department of Biostatistics, Baylor College of Medicine, Houston, TX, USA

    Hau Liu

Authors
  1. Abbas Rana
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  2. Bhamidipati Murthy
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  3. Zachery Pallister
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  4. Michael Kueht
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  5. Ronald Cotton
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  6. N. Thao N. Galvan
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  7. Whiston Etheridge
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  8. Hau Liu
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  9. John Goss
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  10. Christine O’Mahony
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Corresponding author

Correspondence to Abbas Rana.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standard. For this type of study, retrospective, formal consent is not required.

Informed consent

No identifiable patient information was accessed by the authors for this study. Therefore, informed consent was not required.

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Rana, A., Murthy, B., Pallister, Z. et al. Profiling risk for acute rejection in kidney transplantation: recipient age is a robust risk factor. J Nephrol 30, 859–868 (2017). https://doi.org/10.1007/s40620-016-0354-x

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  • DOI: https://doi.org/10.1007/s40620-016-0354-x

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