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Kidney Week

Abstract: PO2165

The Cumulative Dose-Dependent Benefit of Metformin in Kidney Transplantation Recipients

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Kwon, Soie, Seoul National University Hospital Department of Internal Medicine, Jongno-gu, Seoul, Korea (the Republic of)
  • Kim, Yong Chul, Seoul National University Hospital Department of Internal Medicine, Jongno-gu, Seoul, Korea (the Republic of)
  • Kim, Chan-Duck, Kyungpook National University, Daegu, Daegu, Korea (the Republic of)
  • Cho, Jang-Hee, Kyungpook National University, Daegu, Daegu, Korea (the Republic of)
  • Son, Hyung Eun, Seoul National University Bundang Hospital Department of Internal Medicine, Seongnam, Gyeonggi-do, Korea (the Republic of)
  • Jeong, Jong Cheol, Seoul National University Bundang Hospital Department of Internal Medicine, Seongnam, Gyeonggi-do, Korea (the Republic of)
  • Lee, Jeonghwan, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Dongjak-gu, Seoul, Korea (the Republic of)
  • Yoo, Kyung Don, Ulsan University Hospital, Ulsan, Korea (the Republic of)
  • Lee, Jong Soo, Ulsan University Hospital, Ulsan, Korea (the Republic of)
  • Lee, Hajeong, Seoul National University Hospital Department of Internal Medicine, Jongno-gu, Seoul, Korea (the Republic of)
  • Kim, Yon Su, Seoul National University Hospital Department of Internal Medicine, Jongno-gu, Korea (the Republic of)
  • Lee, Jung Pyo, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Dongjak-gu, Korea (the Republic of)
Background

The status of metformin as a primary choice is concrete, moreover it has recently been recommended for advanced chronic kidney disease. Although, the evidence of metformin usage in kidney transplant recipients (KTRs) is lacking. We investigated the effect of metformin in KTRs.

Methods

The primary outcomes were all-cause mortality and death censored graft survival (DCGS) and secondary outcome was biopsy proven acute rejection (BPAR). Cox analysis and propensity score matching were used. Time-varying and marginal structural cox was conducted for HbA1c. A defined daily dose (DDD) of WHO and a penalized spline curve were used to evaluate cumulative effect of metformin.

Results

In 2,048 diabetic KTRs, 1,199 patients were metformin user and 849 patients were non-metformin user. Pre-existing DM patients before transplantation were majority (78.7%) and tend to be less prescribed metformin than NODAT (DM 56.0%; NODAT 68.0%; P<0.001). The metformin user had a lower risk of all-cause mortality, DCGS and BPAR. Even after time varying adjustment of HbA1c, metformin usage was associated with significant reduction in all outcomes. (Table 1) Also, the more cumulative metformin exposure was correlated to the less risk of whole outcomes. (Figure 1)

Conclusion

In conclusion, metformin can be also considered as first-line anti-diabetic treatment in KTRs, not only from the benefit of lower mortality, graft survival and acute rejection, but also cumulative dose dependent protective effect.

Survival analysis
 All-cause mortalityDeath Censored Graft FailureBiopsy Proven Acute Rejection
 aHR95% CIP-valueaHR95% CIP-valueaHR95% CIP-value
Univariate0.28650.1939–0.4232<0.0010.30300.2171–0.4231<0.0010.63520.5203–0.7754<0.001
Model 10.34250.2288–0.5127<0.0010.31650.2231–0.4489<0.0010.57930.4712–0.7122<0.001
Model 20.47610.3066–0.73950.0010.46110.3109–0.6839<0.0010.64260.5114–0.8073<0.001
Model 30.56750.3429–0.93930.0280.44720.2908–0.6879<0.0010.56940.4438–0.7306<0.001
Model 40.76970.4524–1.31000.3000.47950.2821–0.81490.0070.60730.4448–0.82910.002
Model 50.58190.3578–0.94640.0290.44380.2803–0.70270.0010.56270.4339–0.7297<0.001
Model 60.55090.3340–0.90870.0200.44280.2782–0.70470.0010.55390.4272–0.7183<0.001