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Background Modern immunosuppression therapies (ISx) have many side effects, and transplant recipients must take an array of “comedications” to help mitigate complications. Comedication use patterns are not well described in large, representative samples because of lack of data. Methods We integrated national U.S. transplant registry data with pharmacy records (2005–2010) from a large pharmaceutical claims clearinghouse to examine treatments for anemia, metabolic disorders, and infections in relation to ISx regimens in months 6–12 post-transplantation (N = 22,453). Associations of ISx with comedication use (adjusted odds ratio [aOR]) were quantified with multivariate logistic regression including adjustment for recipient, donor, and transplant factors. Results Compared to a reference regimen of tacrolimus, mycophenolic acid, and prednisone, sirolimus-based ISx was associated with significantly more common use of erythropoiesis-stimulating agents (aOR 2.52, 95% confidence interval [CI] 2.06–3.09), iron (aOR 2.26, 95% CI 1.92–2.65), statins (aOR 1.47, 95% CI 1.33–1.63), fibrates (aOR 2.35, 95% CI 1.90–2.90), and phosphorous binders (aOR 2.85, 95% CI 1.80–4.50). Patterns were similar after adjustment for first-year estimated glomerular filtration rate, except the association with phosphorous binders was no longer significant. Cyclosporine-based ISx was associated with more common erythropoiesis-stimulating agent use, including after estimated glomerular filtration rate adjustment (aOR 1.61, 95% CI 1.24–2.10). Compared to those who were being administered triple ISx, recipients receiving tacrolimus-based dual and monotherapies had lower use of statins, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEi/ARBs), and antibacterial agents. Recipients of steroid-free ISx were less commonly treated for post-transplantation diabetes. Conclusions Alternate ISx regimens are associated with varying treatment requirements for hematologic, metabolic. and infectious complications. Comedication use should be considered in the cost-effectiveness and individualization of ISx regimens. [ABSTRACT FROM AUTHOR]

Non-ideal donor lungs are defined as those failing to meet ≥1 ISHLT ideal donor criteria (P/F ratio > 300, age < 55, smoking < 20 pack years, clear CXR, no secretions). Reluctance toward their use remains despite encouraging reports of noninferior outcomes for recipients from several single center studies. Given changes in clinical practice and donor/recipient characteristics over time, we sought to evaluate temporal trends in utilization and outcomes of non-ideal donor lungs. We used SRTR data to identify all adult lung offers from 2005-2018. We used adjusted multi-level logistic regression to quantify temporal trends in utilization and discard rates for non-ideal donor lungs, accounting for donor characteristics and center-level variation. We used adjusted Cox regression to characterize temporal trends in mortality for recipients. We identified 133,649 lungs offered for transplant, 108,828 (81.4%) of which were not recovered. Of 24,821 lungs recovered, 78.9% came from non-ideal donors. In 2005, 4.9% of non-ideal lungs were discarded versus 8.6% in 2018 (p<0.001). Adjusting for donor factors and center-level variation, non-ideal lungs were more likely to be discarded (aOR 2005-2010: 1.43 1.92 2.57 ; 2011-2014: 1.23 1.59 2.06 ; 2015-2018: 1.28 1.77 2.44). However, only 8.1% of variation in discard was attributable to differences between centers. Despite higher likelihood of discard, post-transplant mortality improved over time. Compared to 2005-2010, non-ideal lung recipients from 2015-2018 had a 27% lower mortality risk (aHR= 0.62 0.73 0.86 , p<0.001). From 2015-2018, there were no differences in mortality between recipients of ideal and non-ideal lungs. Recipients of non-ideal donor lungs have experienced rates of mortality equivalent to their ideal counterparts and their outcomes have improved over time. Non-ideal lungs are more likely to be discarded despite the vast majority of recovered lungs failing to meet ISHLT ideal donor criteria. Fully 81.4% of lung offered were not recovered. Future work should define a 'high-risk' donor lung which more consistently confers greater risk to its recipients as well as strategies to improve recovery. [ABSTRACT FROM AUTHOR]

Purpose End stage renal disease (ESRD) is a dreaded complication after cardiac transplantation and is associated with inferior post-transplant survival. In this study, we sought to identify the incidence and risk factors for the development of ESRD in heart transplant recipients. Methods We studied heart transplant recipients in the US between 01/01/2006-12/31/2016 using data from the Scientific Registry of Transplant Recipients. We included recipients greater or equal to 18 years old. We excluded patients with ESRD prior to transplant. For ascertainment of our outcome of interest (ESRD), we linked our cohort data to the United States Renal Data System. ESRD was defined as the initiation of dialysis, waitlisting, or kidney transplantation, whichever was identified first. We used Kaplan-Meier methods to estimate the cumulative incidence of ESRD and used multivariate Cox regression to determine risk factors associated with ESRD. Results We identified 18,982 heart transplant recipients who were at risk for development of ESRD during our study period. Median follow-up time was 3.9 years, and ESRD developed in 666 recipients in a mean of 3.9±2.6 years after heart transplant. The risk of ESRD increased over time. The cumulative incidence at 1, 3, 5 and 10 years was 0.6% (0.5-0.7), 1.8% (1.6-2.0), 3.5% (3.2-3.9), and 9.1% (8.2-10.0), respectively. Pre-transplant risk factors associated with ESRD are shown in Table 1. Conclusion This is the largest study to date looking at ESRD after cardiac transplantation, and we found a ten-year risk of 9.1%. Closely monitoring the modifiable risk factors that we identified might reduce the long-term risk of ESRD. [ABSTRACT FROM AUTHOR]

Purpose End stage renal disease (ESRD) is a dreaded complication after lung transplantation and is associated with inferior post-transplant survival. In this study, we sought to identify the incidence and risk factors for the development of ESRD in lung transplant recipients. Methods We studied lung transplant recipients in the US between 01/01/2006-12/31/2016 using data from the Scientific Registry of Transplant Recipients (SRTR). We included recipients greater or equal to 12 years old. We excluded patients with ESRD prior to transplant. For ascertainment of our outcome of interest (ESRD), we linked our cohort data to the United States Renal Data System (USRDS). ESRD was defined as the initiation of dialysis, waitlisting, or kidney transplantation, whichever was identified first. We used Kaplan-Meier methods to estimate the cumulative incidence of ESRD and used multivariate Cox regression to determine risk factors associated with ESRD. Results Among 17,054 lung transplant recipients, 514 developed ESRD at a mean of 3.57±2.45 years. Median follow up time was 2.9 years. The risk of ESRD increased over time. The cumulative incidence at 1, 3, and 5 years was 0.6% (95% CI, 0.5-0.7), 1.9% (1.7-2.2), and 4.1% (3.6-4.5). Pre-transplant risk factors associated with ESRD are shown in Table 1. Conclusion This is the largest study to date looking at ESRD after lung transplantation, and we found a five-year risk of 4.1%. Closely monitoring modifiable risk factors that we identified might reduce the long-term risk of ESRD. [ABSTRACT FROM AUTHOR]