Temporal and spatial variability of immunosuppressive therapies in transplant patients: An observational study in Italy

Abstract

BackgroundIn immunosuppression after transplantation, several multi-drug approaches are used, involving calcineurin inhibitors (CNI: tacrolimus-TAC or cyclosporine-CsA), antimetabolites (antiMs), mammalian target of rapamycin inhibitors (mTORis), and corticosteroids. However, data on immunosuppressive therapy by organ and its space–time variability are lacking.MethodsAn Italian multicentre observational cohort study was conducted using health information systems. Patients with incident transplant during 2009–2019 and resident in four regions (Veneto, Lombardy, Lazio, and Sardinia) were enrolled. The post-transplant immunosuppressive regimen was evaluated by organ, region, and year.ResultsThe most dispensed regimen was triple-drug therapy for the kidneys [tacrolimus (TAC) + antiM + corticosteroids = 41.5%] and heart [cyclosporin + antiM + corticosteroids = 36.6%] and double-drug therapy for liver recipients (TAC + corticosteroids = 35.4%). Several differences between regions and years emerged with regard to agents and the number of drugs used.ConclusionA high heterogeneity in immunosuppressive therapy post-transplant was found. Further studies are needed in order to investigate the reasons for this variability and to evaluate the risk–benefit profile of treatment schemes adopted in clinical practice.

Determinants of immunosuppressive therapy in renal transplant recipients: an Italian observational study (the CESIT project)

“…Characteristics by comparison groups are shown in Table 1. 2 the Casemix variable is not available in the case of living transplantation 3 the de nition of "Long term care" considers observations beyond the 75th percentile (20 days) of the distribution 4 Row percentages. Data partially available for years prior to 2013 5 Tumours of the kidney are not considered considered…”

“…Patterns of use of immunosuppressive drugs have been described in details in a previous article [4]. In this paper, the comparison groups in study were: CsA vs Tac (1st comparison group) and Tac + mTORi vs Tac + MMF (2nd comparison group).…”

“…A recent article shows a high heterogeneity of the immunosuppressive drug combinations employed in the maintenance phase of solid organ transplantation in the Italian context [4].…”

Effectiveness and safety of immunosuppressive regimens used as maintenance therapy in kidney transplantation: The CESIT study

“…Information on demographical and clinical characteristics of donor and receipt, available nationwide, was linked through a semi-deterministic matching. Details on this procedure are described elsewhere [ 14 , 15 ].…”

“…This work was conducted within the context of the multiregional active pharmacovigilance CESIT project with the aim of improving knowledge about maintenance immunosuppressive therapies prescribed after solid organ transplantation [ 14 ]. Recently, the study group has published an article focused on the immunosuppressive drug utilization patterns among Italian patients who underwent kidney transplantation, showing that a considerable variability in dispensation patterns exists across years, regions, and centres in the country [ 15 ].…”