PD54 Associated Factors Renal Graft Loss Using Real-World Evidence In Brazil

• Published in: International journal of technology assessment in health care 2018, Vol.34 (S1), p.148-149
• Main Authors: Gomes, Rosângela Maria, Barbosa, Wallace Breno, de Assis Acurcio, Francisco, Guerra, Augusto Afonso
• Format: Article
• Language: English
• Subjects: Age; Azathioprine; Calcineurin; Calcineurin inhibitors; Chemotherapy; Corticosteroids; Cyclosporins; Diabetes; Diabetes mellitus; Diagnosis; Dialysis; Drug development; Drug therapy; Drugs; Economic impact; Grafting; Hemodialysis; Hypertension; Immunosuppressive agents; Impact analysis; Information systems; Kidney diseases; Kidney transplantation; Kidney transplants; Medical personnel; Mycophenolic acid; Patients; Poster Display Presentations; Public health; Rapamycin; Statistical models; Steroids; Subsystems; Tacrolimus; Transplantation; Transplants; Transplants & implants
• ISSN: 0266-4623; 1471-6348
• DOI: 10.1017/S0266462318003173

Introduction:Renal transplantation is considered a cost-effective treatment compared to dialysis and represents a significant percentage of public health resources. Post-transplant treatment requires the use of three immunosuppressive drugs. The immunosuppressive regimens consists of a corticosteroid, a calcineurin inhibitor (cyclosporine or tacrolimus) and an antiproliferative agent (azathioprine or mycophenolate) and also by sirolimus or everolimus. In Brazil, the Unified Health System (as known as Sistema Único de Saúde - SUS) is responsible for 95 percent of all kidney transplants performed, as well as ensuring access to immunosuppressive drugs. Therefore, there is a huge and growing economic impact caused by the distribution of these drugs in SUS. We evaluated the factors associated with kidney graft loss in patients who received deceased donor organ and used maintenance immunosuppressive regimens in SUS, in fifteen years.Methods:We analyzed a nationwide cohort of kidney transplant recipients from January 2000 to December 2015 developed through deterministic-probabilistic linkage of SUS administrative databases: Hospital Information System (SIH/SUS); Subsystem for High Complexity Procedures (SIA/SUS) and the Mortality Information System (SIM). Graft loss was defined as death or dialysis for more than three months. All regimens included corticosteroid. We used Cox proportional hazards model to evaluate the factors associated with progression to graft loss.Results:In total, 18,333 patients were included; 58.5 percent used tracolimus+mycophenolate, 11.7 percent cyclosporine+mycophenolate, 8.9 percent tacrolimus+azathyoprine, 5.5 percent cyclosporine+azathyoprine and 15.4 percent received other immunosuppressive regimens (sirolimus+mycophenolate, everolimus+mycophenolate, tacrolimus, mycophenolate, cyclosporine, azathyoprine) . Most patients were male with a median age of 46 years. A higher risk of graft loss was associated with the use of tracolimus+mycophenolate (HR = 1.069; 95% CI, 0.999–1.146), sirolimus+mycophenolate (HR1.395;95% CI, 1 .150–1.692), tracolimus (monotherapy) (1.468;1.239–1.739); mycophenolate (monotherapy) (1.297;1.126–1.493), male gender (1.144; 1.072–1.221), an additional year of age (1.010; 1.007–1.013), a median dialysis period greater than 38 months (1.266; 1.182–1.356), a diagnosis of diabetes (1.211; 1.071–1.367) and a diagnosis of arterial hypertension (1.209; 1.134–1.288) (HR=1.468;95% CI,1.239 −1.739); mycophenolate (monother