Date: Tuesday, May 5, 2015
Session Time: 5:30pm-6:30pm
Presentation Time: 5:30pm-6:30pm
Location: Exhibit Hall E
Purpose: To evaluate the effects of a reduced intensity immunosuppression protocol on drug costs and rates of BK viremia and readmissions.
Methods: In response to high rates of BK viremia, our center implemented a reduced intensity immunosuppression protocol in February 2014. The new protocol reduced the proportion of patients receiving anti-thymocyte globulin induction, decreased tacrolimus trough goals, and decreased corticosteroid exposure. This is a retrospective study of all adult kidney and SPK transplants from July 2011 through October 2014. Patients were divided into 2 groups according to transplant date: group 1 transplanted before and group 2 transplanted after implementation of new protocol (February 3, 2014). The primary outcome was to determine if the new protocol affected the incidence of BK viremia. Secondary outcomes were to determine the protocol effects on 30 and 90 day readmission rates and drug cost savings.
Results: During the study period, 173 patients were transplanted (140 patients in group 1 and 33 patients in group 2). Group 1 had a 25.7% incidence of BK viremia versus 15.6% in group 2 (p=0.26). In group 1, 33% of patients were readmitted within 30 days versus 15.2% in group 2 (p=0.056). Ninety day readmission rates were 45% in group 1 versus 15.4% in group 2 (p<0.01). The rate of biopsy proven rejection within 1 year was 6.4% for group 1. The 1 year rejection rate for group 2 cannot yet be determined, although, as of the date of this submission, only 1 of the 33 patients has had a biopsy proven rejection. As a result of the new protocol, 10 patients received basiliximab induction who would have otherwise received anti-thymocyte globulin induction (6 mg/kg) according to the previous protocol. This amounted to a drug cost savings of $80,478.
Conclusion: Although the incidence of BK viremia was numerically reduced, small sample size may have prevented this from reaching statistical significance. Reducing complications of over-immunosuppression with the revised protocol may be responsible for significantly reducing 90-day readmission rates. Along with improved outcomes, reducing the use of depleting antibody induction resulted in significant cost savings. Further analysis with additional patients and longer followup is warranted.
To cite this abstract in AMA style:Mariski M, DeGolovine A, Dar W, Bynon J, Adrogué H, Hobeika M. Reduced Intensity Immunosuppression Protocol Lowers Drug Costs and May Decrease Incidences of BK Viremia and Readmissions After Kidney and Kidney/Pancreas Transplant [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/reduced-intensity-immunosuppression-protocol-lowers-drug-costs-and-may-decrease-incidences-of-bk-viremia-and-readmissions-after-kidney-and-kidneypancreas-transplant/. Accessed April 20, 2021.
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