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Kidney Week

Abstract: PO2059

Immunosuppression, Osteoporosis, and Fractures in Younger and Older Adults After Kidney Transplantation

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Lentine, Krista L., Saint Louis University School of Medicine, Saint Louis, Missouri, United States
  • Kuppachi, Sarat C., The University of Iowa Hospitals and Clinics Department of Pathology, Iowa City, Iowa, United States
  • Li, Ruixin, Saint Louis University School of Medicine, Saint Louis, Missouri, United States
  • Caliskan, Yasar, Saint Louis University School of Medicine, Saint Louis, Missouri, United States
  • Cheungpasitporn, Wisit, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Schnitzler, Mark, Saint Louis University School of Medicine, Saint Louis, Missouri, United States
  • McAdams-DeMarco, Mara, Johns Hopkins University, Baltimore, Maryland, United States
  • Dharnidharka, Vikas R., Washington University in St Louis, St Louis, Missouri, United States
  • Ahn, JiYoon B., Johns Hopkins University, Baltimore, Maryland, United States
  • Bae, Sunjae, Johns Hopkins University, Baltimore, Maryland, United States
  • Segev, Dorry L., Johns Hopkins University, Baltimore, Maryland, United States
  • Hess, Gregory, Drexel University, Philadelphia, Pennsylvania, United States
  • Bunnapradist, Suphamai, University of California Los Angeles, Los Angeles, California, United States
  • Randall, Henry B., Saint Louis University School of Medicine, Saint Louis, Missouri, United States
  • Axelrod, David, The University of Iowa Hospitals and Clinics Department of Pathology, Iowa City, Iowa, United States
Background

Osteoporosis and fractures are important complications among kidney transplant recipients (KTx) that may be exacerbated by immunosuppression (ISx) and aging. We examined relationships of osteoporosis and fractures with ISx among older and younger adults in a national sample of Medicare beneficiaries.

Methods

We examined USRDS data (2005-2017) to explore associations of ISx regimens (within 6 mo) with osteoporosis and fracture diagnoses >6 mo-to-3 yr post-KTx among Medicare-insured younger (age <55) and older (aged ≥ 55) adults. We used multivariate Cox regression with inverse propensity weighting to compare cancer risk vs. reference regimen of Thymoglobulin (TMG) or Alemtuzumab (ALEM) + Tacrolimus + antimetabolite + prednisone.

Results

Among 67,362 KTx Medicare-insured recipients, the 3-year composite risk of osteoporosis and fractures varied by age and ISx regimen. Among older adults, incidence ranged from 11% with TMG/ALEM no Pred, to 16% in those managed with CsA and mTORi-based regimens (Fig. A) In adjusted models, TMG/ALEM + no Pred was y associated with lower risk (aHR, 0.760.840.792) than TMG/ALEM + triple therapy (Fig. B). Conversely, mTORi-based regimens (aHR,1.081.231.40) and CsA-based regimens (aHR, 1.071.211.38) were associated with greater risk. Patterns were generally similar but relative impacts were amplified in younger patients, including greater benefits of steroid-avoidance (aHR, 0.550.551.38).

Conclusion

Among Medicare insured KTx recipients, steroid avoidance after TMG/ALEM inductions is associated with reduced risk of fractures and osteoporosis. Fracture risk is a consideration in tailoring ISx in older KTx recipients.

Osteoporosis and fracture incidence (A) and adjusted risks (B) in relation to ISx, in younger and older adult KTx recipients

Funding

  • NIDDK Support