Treatment Switches, Patterns, and Outcomes in Adult and Pediatric Patients Undergoing Kidney Transplantation Between 2000 and 2019: A Retrospective United States Claims Database Study

Abstract

BackgroundImmunosuppressive regimens are imperative for improving patient and graft survival following kidney transplantation in patients with kidney failure. However, real-world evidence regarding treatments and outcomes in these patients is scarce. ObjectiveTo describe the treatment switches (assessed by line of treatment [LOT]), patterns, and outcomes in patients who underwent kidney transplantation in the United States (US). MethodsThis retrospective cohort study used claims data from the Optum Research Database in the US. Adult and pediatric patients undergoing a kidney transplantation between January 1, 2000, and June 30, 2019, who had ≥1 year of baseline and follow-up visits and continuous enrollment in the Optum Research Database, were included. ResultsData from 7159 patients (6833, adult; 326, pediatric) were included. Mean (standard deviation [SD]) age for adult and pediatric patients was 51.4 (12.8) and 10.4 (5.1) years, respectively. Mean (SD) number of LOTs in patients with ≥1 LOT (N = 7004) was 4.1 (2.6) LOTs. Tacrolimus, anti-proliferative agents and prednisone were the most frequently prescribed immunosuppressants. No strong correlations were identified between switching from LOT1 to LOT2 and potential predictors of treatment switches. The proportion of patients who did not experience graft loss gradually decreased between month 3 and month 120 (72%-36%), driven by return to dialysis (66%-18%). A slower decrease was observed for graft rejection (98%-84%), re-transplantation (98%-93%), and graft removal (98%-92%). ConclusionsWe described treatment switches, patterns, and outcomes in patients who underwent kidney transplantation in the US. Future analytical studies are needed to test hypotheses derived from these observations.