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Abstract: FR-PO831

Proton Pump Inhibitor Use in Kidney Transplant Recipients: A Population-Based Study

Session Information

Category: Transplantation

  • 2002 Transplantation: Clinical

Authors

  • Kiberd, James Alan, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  • Quinn, Robert R., University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  • Ravani, Pietro, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  • Jeong, Rachel, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  • Lam, Ngan, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  • Clarke, Alix, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
Background

Kidney transplant recipients are commonly prescribed proton pump inhibitors (PPIs), but due to concerns of long-term adverse events, chronic use should be limited to those with specific indications.

Methods

We conducted a retrospective, population-based cohort study using linked healthcare databases in Alberta, Canada to study PPI use in prevalent adult kidney-only transplant recipients (2008-2017) who were at least 1-year post-transplant. We compared recipients with evidence of a PPI prescription in the 3 months prior to study entry to those with a histamine-2-receptor antagonist (H2Ra) fill and those with neither. The primary outcome was ongoing or new PPI use and patterns of use, including frequency and duration of therapy, and assessment of indication for PPI use.

Results

We identified 1,823 kidney transplant recipients, of whom 868 (48%) were on a PPI, 215 (12%) were on a H2Ra, and 740 (41%) were on neither at baseline. Over a median follow-up of 5.4 years (interquartile range [IQR] 2.6-9.3), there were almost 45,000 unique PPI prescriptions dispensed, the majority (80%) of which were filled by initial PPI users. Recipients who were on a PPI at baseline would spend 91% (IQR 70-98) of their graft survival time on a PPI in follow-up, of which Nephrologists were the main prescribers. We identified an indication for ongoing PPI use in 54% of the PPI group with the most common indication being concurrent antiplatelet use (26%).

Conclusion

Most kidney transplant recipients are on a PPI at or beyond the 1-year post-transplant date and are likely to stay on a PPI in follow-up. Almost half of the recipients in our study did not have an identifiable indication for ongoing PPI use. Nephrologists frequently prescribe PPIs to kidney transplant recipients and should be involved in deprescribing initiatives to reduce polypharmacy and its associated risks.