Sirolimus in Geriatric Kidney Transplantation: Modification of Outcomes by Pre-Transplant History of Malignancy or Cardiovascular Disease

H. Ibrahim¹, C. Chen², K. Alquadan³, X. Wen⁴, K. L. Womer³, A. H. Santos Jr¹

¹College of Medicine, Div. of Nephrology, Hypertension & Renal Transplantation, Univ. of Florida, Gainesville, FL, ²College of Pharmacy, Univ. of Florida, Gainesville, FL, ³College of Medicine, Div. of Nephrology, Hypertension & Renal Transplantation, Univ. of Florida, Gainesville, FL, ⁴College of Pharmacy, Univ. of Rhode Island, Kingston, RI

Meeting: 2019 American Transplant Congress

Abstract number: D338

Keywords: Elderly patients, Graft failure, Immunosuppression, Rapamycin

Session Information

Session Name: Poster Session D: PTLD/Malignancies: All Topics

Session Type: Poster Session

Date: Tuesday, June 4, 2019

Session Time: 6:00pm-7:00pm

Presentation Time: 6:00pm-7:00pm

Location: Hall C & D

*Purpose: We analyzed the outcomes associated with sirolimus (SRL)-regimens in geriatric (>/=65-year-old) kidney transplant recipients (KTRs).

*Methods: Using 2000-2016 Scientific Registry of Transplant Recipients data, Cox regressions were used to analyze outcomes in the overall and comorbidity-stratified cohorts of geriatric KTRs on SRL-with-steroids (S) and cyclosporine (CSA), tacrolimus (Tac), or mycophenolate (MPA) consistently for >/=6 months through the 12th-month of transplant.

*Results: IIn the main model, SRL-MPA-S and SRL-Tac-S were significantly, and SRL-CSA-S was suggestively associated with higher all-cause death and overall graft loss risks than the reference (Tac-MPA-S) regimen in geriatric KTRs [Fig.1 ].

Subgroup analyses using Tac-MPA-S as reference regimen showed that:

(1) SRL-Tac-S was associated with increased risks of all-cause death and overall graft loss in geriatric KTRs with pre-transplant cancer history compared to those without pre-transplant cancer history [all-cause death(HR=2.60, 95% CI=1.45-4.64 vs. HR=1.18, 95% CI=0.95-1.47; P= 0.005 ) and overall graft loss (HR=2.58, 95% CI=1.48-4.51 vs. HR=1.26, 95% CI=1.03-1.54; P= 0.009)], [Fig. 2];

(2). SRL-MPA-S was associated with significant risks of all-cause death and overall graft loss in geriatric KTRs without, not in those with a pre-transplant cancer history [Fig. 2];

(3) A pre-transplant cancer history did not modify the risk of all-cause death or overall graft loss associated with SRL-MPA-S and SRL-CSA-S [Fig. 2]; and

(4) A pre-transplant CVD history did not modify the risks of outcomes associated with SRL-steroids-regimens in geriatric KTRs [data not shown].

*Conclusions: In geriatric KTRs, SRL-Steroids-regimens are associated with higher risks of death and graft loss than Tac-MPA-S; these risks are aggravated by a pre-transplant cancer history in KTRs on SRL-Tac-S .

To cite this abstract in AMA style:

Ibrahim H, Chen C, Alquadan K, Wen X, Womer KL, Jr AHSantos. Sirolimus in Geriatric Kidney Transplantation: Modification of Outcomes by Pre-Transplant History of Malignancy or Cardiovascular Disease [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/sirolimus-in-geriatric-kidney-transplantation-modification-of-outcomes-by-pre-transplant-history-of-malignancy-or-cardiovascular-disease/. Accessed May 18, 2025.

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