Transplantation in the Twenty-First CenturyGeneral clinical transplantationRace, Calcineurin Inhibitor Exposure, and Renal Function After Solid Organ Transplantation
Section snippets
Study Population and Participants
We conducted a retrospective cohort study utilizing an administrative-linked electronic database of patients in the Henry Ford Health System in Michigan. The system includes several hospitals, a multispecialty physician group of approximately 1000 physicians, and an affiliated health maintenance organization. The system maintains a central repository of administrative data that we queried for this study. Using electronic data sources, we identified 1609 patients 18 years of age or older who
Results
Of the 1609 patients identified, 1109 patients were treated with tacrolimus (271 African-Americans) and 500 were treated with cyclosporine (113 African-Americans) (Fig 1). Demographics and baseline characteristics stratified by race are shown in Table 1. History of hypertension was more prevalent in African-Americans than whites. African-Americans were younger, had a higher proportion of females, and slightly higher eGFRs than whites. Multivariate modeling adjusted for age, gender,
Discussion
The introduction of CNIs has revolutionized transplantation medicine. They are now widely used as immunosuppressant therapy for liver, renal, cardiac, and lung transplantation. Patients treated with the CNIs cyclosporine and tacrolimus are at a high risk of developing renal injury [20]. Nephrotoxicity can be divided into acute and chronic forms. Acute nephrotoxicity is primarily associated with profound alterations in vascular flow [21], [22], [23] and vasoconstriction of preglomerular afferent
Acknowledgments
The authors express their gratitude to Stephanie Stephens for expert librarian assistance in formatting the manuscript and for expert linguistic revision of the manuscript.
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