Induction immunosuppression and post-transplant diabetes mellitus: a propensity-matched cohort study

Frontiers in Endocrinology

Endocrinology

Elizabeth Mostofsky¹  Suruchi K. Gupta²  Murray A. Mittleman³  Ali Hage⁴  Shweta R. Motiwala⁵ 

[1] Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States;Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States;Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States;Harvard Medical School, Boston, MA, United States;Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States;Harvard Medical School, Boston, MA, United States;Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States;Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States;London Health Sciences Centre, Schulich School of Medicine, Western University, London, ON, Canada;Harvard Medical School, Boston, MA, United States;Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States;

关键词: induction;    immunosuppression;    diabetes;    cardiac;    transplant;    heart;    post-transplant diabetes mellitus;   

DOI  :  10.3389/fendo.2023.1248940

 received in 2023-06-27, accepted in 2023-10-02,  发布年份 2023

来源: Frontiers

【 摘 要 】

IntroductionPost-transplant diabetes mellitus (PTDM) is a common complication among cardiac transplant recipients, causing diabetes-related complications and death. While certain maintenance immunosuppressive drugs increase PTDM risk, it is unclear whether induction immunosuppression can do the same. Therefore, we evaluated whether induction immunosuppression with IL-2 receptor antagonists, polyclonal anti-lymphocyte antibodies, or Alemtuzumab given in the peri-transplant period is associated with PTDM.MethodsWe used the Scientific Registry of Transplant Recipients database to conduct a cohort study of US adults who received cardiac transplants between January 2008-December 2018. We excluded patients with prior or multiple organ transplants and those with a history of diabetes, resulting in 17,142 recipients. We created propensity-matched cohorts (n=7,412) using predictors of induction immunosuppression and examined the association between post-transplant diabetes and induction immunosuppression by estimating hazard ratios using Cox proportional-hazards models.ResultsIn the propensity-matched cohort, the average age was 52.5 (SD=13.2) years, 28.7% were female and 3,706 received induction immunosuppression. There were 867 incident cases of PTDM during 26,710 person-years of follow-up (32.5 cases/1,000 person-years). There was no association between induction immunosuppression and post-transplant diabetes (Hazard Ratio= 1.04, 95% confidence interval 0.91 – 1.19). Similarly, no associations were observed for each class of induction immunosuppression agents and post-transplant diabetes.ConclusionThe use of contemporary induction immunosuppression in cardiac transplant patients was not associated with post-transplant diabetes.

【 授权许可】

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Copyright © 2023 Gupta, Mostofsky, Motiwala, Hage and Mittleman