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Kidney Week

Abstract: TH-PO840

Association of Metformin with Rejection and Graft Survival in Kidney Transplant Recipients Taking Tacrolimus with Post-Transplantation Diabetes Mellitus

Session Information

Category: Transplantation

  • 2102 Transplantation: Clinical

Authors

  • Lee, Jaeyun, Asan Medical Center, Songpa-gu, Seoul, Korea (the Republic of)
  • Jung, Jiyun, Dongguk University Ilsan Hospital, Goyang, Gyeonggi-do, Korea (the Republic of)
  • Cho, Haeyon, Asan Medical Center, Songpa-gu, Seoul, Korea (the Republic of)
  • Lee, Dongyeon, Asan Medical Center, Songpa-gu, Seoul, Korea (the Republic of)
  • Park, Jae Yoon, Dongguk University Ilsan Hospital, Goyang, Gyeonggi-do, Korea (the Republic of)
  • Kim, Hyosang, Asan Medical Center, Songpa-gu, Seoul, Korea (the Republic of)
Background

Tacrolimus is a pivotal maintenance immunosuppressive drug in kidney transplantation (KT). Although diabetogenic property of tacrolimus is still an inevitable concern, it can reduce the risk of acute rejection and improve graft survival. Metformin, despite limited randomized controlled trial, has been found to be safe and effective in patients with post-transplantation diabetes mellitus. We aimed to investigate the effect of metformin on acute rejection and graft survival in kidney transplant recipients taking tacrolimus.

Methods

A number of 410 PTDM patients prescribed tacrolimus between 2000 and 2018 were collected. We conducted propensity score matching between the metformin and non-metformin group and evaluated the effects of metformin on the occurrence of T-cell mediated rejection and antibody-mediated rejection, and graft survival.

Results

Among 410 patients taking tacrolimus, 273 patients were treated with metformin for the average of 3.8 years. After 1:1 matching, cumulative incidences of TCMR (p=0.029) and graft failure (p=0.025) in the metformin group was lower than the non-metformin group, while no significant difference was observed in ABMR. Metformin use was associated with a reduced risk of TCMR (HR 0.40, 95% CI 0.18-0.90, p=0.026) and graft failure (HR 0.32, 95% CI 0.14-0.72, p=0.006). There was no significant difference in tubulitis, interstitial inflammation, and endarteritis scores of TCMR between the metformin and the non-metformin group.

Conclusion

Our study demonstrates that combination therapy with metformin and tacrolimus in KT recipients with PTDM is associated with a lower risk of acute rejection and graft failure.

Figure1. The occurrence probability of TCMR (A), ABMR (B), and graft failure (C)