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10.1097/TP.0000000000004251

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35765133!9521389!35765133
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suck abstract from ncbi


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pmid35765133      Transplantation 2022 ; 106 (10): e441-e451
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  • The Mycophenolate-based Immunosuppressive Regimen Is Associated With Increased Mortality in Kidney Transplant Patients With COVID-19 #MMPMID35765133
  • Requiao-Moura LR; Modelli de Andrade LG; de Sandes-Freitas TV; Cristelli MP; Viana LA; Nakamura MR; Garcia VD; Manfro RC; Simao DR; Almeida RAMB; Ferreira GF; Costa KMAH; de Lima PR; Pacheco-Silva A; Charpiot IMMF; Deboni LM; Ferreira TCA; Mazzali M; Calazans CAC; Oria RB; Tedesco-Silva H; Medina-Pestana J
  • Transplantation 2022[Oct]; 106 (10): e441-e451 PMID35765133show ga
  • BACKGROUND: The chronic use of immunosuppressive drugs is a key risk factor of death because of coronavirus disease 2019 (COVID-19) in kidney transplant recipients (KTRs), although no evident association between the class of immunosuppressive and outcomes has been observed. Thus, we aimed to compare COVID-19-associated outcomes among KTRs receiving 3 different immunosuppressive maintenance regimes. METHODS: This study included data from 1833 KTRs with COVID-19 diagnosed between March 20 and April 21 extracted from the national registry before immunization. All patients were taking calcineurin inhibitor associated with mycophenolate acid (MPA, n = 1258), azathioprine (AZA, n = 389), or mammalian targets of rapamycin inhibitors (mTORi, n = 186). Outcomes within 30 and 90 d were assessed. RESULTS: Compared with patients receiving MPA, the 30-d (79.9% versus 87.9% versus 89.2%; P < 0.0001) and 90-d (75% versus 83.5% versus 88.2%; P < 0.0001) unadjusted patient survivals were higher in those receiving AZA or mTORi, respectively. Using adjusted multivariable Cox regression, compared with patients receiving AZA, the use of MPA was associated with a higher risk of death within 30 d (adjusted hazard ratio [aHR], 1.70; 95% confidence interval [CI], 1.21-2.40; P = 0.003), which was not observed in patients using mTORi (aHR, 0.78; 95% CI, 0.45-1.35; P = 0.365). At 90 d, although higher risk of death was confirmed in patients receiving MPA (aHR, 1.46; 95% CI, 1.09-1.98; P = 0.013), a reduced risk was observed in patients receiving mTORi (aHR, 0.59; 95% CI, 0.35-0.97; P = 0.04) compared with AZA. CONCLUSIONS: This national cohort data suggest that, in KTRs receiving calcineurin inhibitor and diagnosed with COVID-19, the use of MPA was associated with higher risk of death, whereas mTORi use was associated with lower risk of death.
  • |*COVID-19[MESH]
  • |*Kidney Transplantation/adverse effects[MESH]
  • |Azathioprine[MESH]
  • |Calcineurin Inhibitors/adverse effects[MESH]
  • |Enzyme Inhibitors[MESH]
  • |Humans[MESH]
  • |Immunosuppressive Agents/adverse effects[MESH]
  • |Mycophenolic Acid/adverse effects[MESH]
  • |Sirolimus/adverse effects[MESH]


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