(066) Low Serum Testosterone and Mortality After Solid Organ Transplantation: A Multi-institutional Analysis of the TriNetX Research Network

Abstract

Abstract Introduction Low serum testosterone has previously been suggested as a predisposing factor contributing to mortality after solid organ transplant. Previous studies on this topic stem from single-center retrospective series. Objective To determine the impact of low serum testosterone as a risk factor for mortality after solid organ transplantation using TriNetX, a large de-identified, multi-institutional database. Methods Data source, Patient Selection, and Outcomes We compiled all clinical data from the TriNetX research network, a health research network (with waiver from Western IRB) that provides de-identified clinical information from 58 health care organizations, and over 80 million patients located within the United States. We selected male patients (age ≥ 18) with a history of lung, kidney, liver, heart, or pancreas transplant. Cases were included if serum testosterone was drawn within one year before transplant. We excluded all patients previously on testosterone therapy. We categorized patients into two groups, based on testosterone levels. We defined patients as having low testosterone (Low T) by the following criteria: total testosterone < 300 (ng/Dl), or a diagnosis of hypogonadism (ICD-10: E29.1). For all patients, clinical characteristics/demographics including comorbidities, laboratory findings, and medication use were compared using descriptive statistics. Our outcomes of interest were mortality at 1-year, 3-year, or at any time. Statistical analyses We evaluated differences in baseline characteristics between testosterone levels (Normal T, or Low T), using chi-square or Fisher’s exact test for categorical data and an independent t-test for continuous data. To address potential confounders that could bias our results, we used a propensity score weighted regression matched on age, race/ethnicity, comorbid conditions, multiple transplant status, and immunosuppressant use. A Cox regression model was used to determine the probability of mortality. All analyses were performed using R version 4.0.4. Results A total of 1,762 men were identified with solid organ transplants. Of these, 792 men met criteria for low testosterone (Table 1). Low testosterone correlated with higher rates of mortality at 1 year, 3 years, and all-time mortality (Figure 1). Conclusions Low testosterone at the time of transplant is correlated with mortality up to 3 years after organ transplantation. Future work will focus on individual organ transplants and whether modifying this risk factor with testosterone therapy changes outcomes. Disclosure No