(062) Testosterone Therapy Improves Mortality after Solid Organ Transplant

Abstract

Abstract Introduction Low testosterone has been suggested as a contributor to mortality and rejection after solid organ transplant. Whether testosterone therapy specifically improves these outcomes is unknown. Objective To determine whether treatment of low testosterone with testosterone therapy is associated with improved rejection or mortality after solid organ transplant using TriNetX, a large deidentified, multi-institutional database. Methods We compiled all clinical data from the TriNetX research network, a globally federated health research network (with waiver from Western IRB) that provides de-identified clinical information from 58 heath care organizations, and over 80 million patients located within the United States. We selected male patients (aged ≥ 18) with a history of lung, kidney, liver, heart, or pancreas transplant. We categorized patients into two groups, based on prescription for testosterone therapy. For all patients, we collected clinical information including demographics, comorbidities, laboratory findings, and medication use. Our outcomes of interest were 1-year, 3-year, and all-time mortality, as well as allograft rejection. We evaluated differences in baseline characteristics between testosterone level (Normal T, or Low T), using chi-square or Fisher’s exact test for categorical data (presented as frequencies and percentages), and independent t-test for continuous data. To address potential confounders that could bias our results, we used a propensity score weighted regression (inverse probability of treatment weighting), matched on age, race/ethnicity, comorbid conditions, multiple transplant status, and immunosuppressant use. Multivariable logistic regression was used to model outcome of transplant rejection, on the predictors of testosterone level, testosterone therapy, and their interaction, while a cox regression model was used to determine probability of mortality. Results A total of 1,762 men were identified with solid organ transplants. 262 (14.9 %) met criteria for low testosterone and had a history a prescription of testosterone therapy. Baseline characteristics were similar between the two groups (Table 1). After matching for existing patient characteristics, outcomes showed that a prescription for testosterone therapy was associated with improved mortality after organ transplant. The risk of mortality was reduced at 1 year (HR 0.33), 3 years (HR0.57) and for all time mortality (HR 0.61) among patients treated with testosterone therapy. No effect of testosterone treatment was seen with regards to allograft rejection (data not shown). Conclusions Testosterone therapy may improve mortality in men with low serum testosterone following solid organ transplant. Further studies are required to determine when and what patients derive most benefit from testosterone therapies, particularly as the result does not appear to be driven by reduced allograft rejection. Disclosure No