Association of Pretransplant Immunosuppression with Posttransplant Complications in Kidney Recipients
Acta Cytologica, cilt.12, sa.1, ss.824-833, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 12 Sayı: 1
- Basım Tarihi: 2026
- Doi Numarası: 10.1159/kdd/adkag005
- Dergi Adı: Acta Cytologica
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CINAHL, EMBASE, MEDLINE
- Sayfa Sayıları: ss.824-833
- Anahtar Kelimeler: Immunosuppression, Kidney transplantation, New-onset diabetes after transplantation, Osteoporosis, Pancreatitis
- Bursa Uludağ Üniversitesi Adresli: Evet
Özet
Introduction: Renal transplantation is the most effective treatment for end-stage renal disease. Long-term immunosuppressive therapy is essential for graft survival but is associated with adverse outcomes. Most patients with glomerulonephritis receive immunosuppressive therapy before transplantation; however, the posttransplant consequences of this exposure remain unclear. This study evaluated the association between pretransplant immunosuppression (PTI) and posttransplant complications. Methods: This retrospective study screened 1,000 renal transplant recipients treated between 1999 and 2018. Fifty patients who received PTI were matched with 50 controls without prior immunosuppression based on age, sex, and transplantation period. Outcomes included rejection, graft function, infections, metabolic complications, and malignancy. Total cumulative immunosuppressive exposure was also assessed. Results: Graft outcomes and complication rates were similar between the groups. Rejection, infectious complications, and malignancy did not differ significantly. However, new-onset diabetes after transplantation (NODAT) was more frequent in the PTI group. Higher cumulative steroid exposure was associated with osteoporosis, whereas longer cumulative immunosuppressive exposure was associated with pancreatitis. In multivariable analysis, PTI showed a trend toward higher odds of NODAT after adjustment for age and BMI, although this association did not reach statistical significance (OR: 4.98, 95% CI: 0.90–27.44; p = 0.065). PTI was not independently associated with osteoporosis after adjustment. Conclusion: PTI was associated with a higher unadjusted incidence of NODAT, although this association was not confirmed after multivariable adjustment. Higher cumulative steroid exposure was associated with osteoporosis. These exploratory findings warrant cautious interpretation but may support careful assessment of PTI exposure and avoidance of prolonged steroid use when clinically feasible.