PMID- 24162246
OWN - NLM
STAT- MEDLINE
DCOM- 20140527
LR  - 20221207
IS  - 1534-6080 (Electronic)
IS  - 0041-1337 (Linking)
VI  - 97
IP  - 5
DP  - 2014 Mar 15
TI  - Concomitant proton pump inhibitors with mycophenolate mofetil and the risk of 
      rejection in kidney transplant recipients.
PG  - 518-24
LID - 10.1097/01.tp.0000436100.65983.10 [doi]
AB  - BACKGROUND: Recent pharmacokinetic studies have demonstrated that proton pump 
      inhibitors (PPI) reduce exposure of mycophenolic acid. However, the clinical 
      significance of this drug-drug interaction on transplantation outcomes has not 
      been determined. METHODS: This was a retrospective cohort study in kidney 
      transplant recipients who were prescribed rabbit antithymocyte globulin, 
      calcineurin inhibitor, mycophenolate mofetil, and steroids. We evaluated the 
      impact of PPI use on the 1-year rates of biopsy-proven acute rejection (BPAR). 
      RESULTS: Two hundred thirteen patients who were prescribed PPI were compared with 
      384 patients who were on standard acid-suppressive therapy with ranitidine. BPAR 
      occurred in similar rates in both groups (15% vs. 12%; P=0.31). In a 
      multivariable analysis, black race was associated with a higher risk of rejection 
      (risk ratio [RR], 2.38; 95% confidence interval [CI], 1.41-4.03). While 
      controlling for rejection risk factors, PPI exposure was associated with an 
      increased risk of rejection in black patients (RR, 1.93; 95% CI, 1.18-3.16) but 
      not in non-black patients (RR, 0.54; 95% CI, 0.19-1.49). At 1 year, BPAR type, 
      BPAR grade, patient and graft survival, graft function, and time to BPAR were not 
      associated with PPI exposure. CONCLUSION: In this retrospective study, PPI use in 
      the first transplant year was associated with an increased risk for BPAR in black 
      patients but not in non-black patients. It is possible that a reduction in 
      mycophenolic acid exposure contributed to the increased risk.
FAU - Knorr, John P
AU  - Knorr JP
AD  - 1 Department of Pharmacy, Einstein Medical Center, Philadelphia, PA. 2 Department 
      of Statistics, Einstein Medical Center, Philadelphia, PA. 3 Department of 
      Medicine, Einstein Medical Center, Philadelphia, PA. 4 Department of Surgery, 
      Einstein Medical Center, Philadelphia, PA. 5 Address correspondence to: John P. 
      Knorr, Pharm.D., B.C.P.S., Department of Pharmacy, Einstein Medical Center, 5501 
      Old York Road, Philadelphia, PA.
FAU - Sjeime, Mariel
AU  - Sjeime M
FAU - Braitman, Leonard E
AU  - Braitman LE
FAU - Jawa, Pankaj
AU  - Jawa P
FAU - Zaki, Radi
AU  - Zaki R
FAU - Ortiz, Jorge
AU  - Ortiz J
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Transplantation
JT  - Transplantation
JID - 0132144
RN  - 0 (Immunosuppressive Agents)
RN  - 0 (Proton Pump Inhibitors)
RN  - HU9DX48N0T (Mycophenolic Acid)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Black People
MH  - Cohort Studies
MH  - Drug Interactions
MH  - Female
MH  - Graft Rejection/*epidemiology/ethnology
MH  - Humans
MH  - Immunosuppressive Agents/*therapeutic use
MH  - Incidence
MH  - *Kidney Transplantation
MH  - Male
MH  - Middle Aged
MH  - Mycophenolic Acid/*analogs & derivatives/therapeutic use
MH  - Proton Pump Inhibitors/*therapeutic use
MH  - Racial Groups
MH  - Retrospective Studies
MH  - Risk Factors
MH  - *Transplantation
MH  - Treatment Outcome
EDAT- 2013/10/29 06:00
MHDA- 2014/05/28 06:00
CRDT- 2013/10/29 06:00
PHST- 2013/10/29 06:00 [entrez]
PHST- 2013/10/29 06:00 [pubmed]
PHST- 2014/05/28 06:00 [medline]
AID - 10.1097/01.tp.0000436100.65983.10 [doi]
PST - ppublish
SO  - Transplantation. 2014 Mar 15;97(5):518-24. doi: 
      10.1097/01.tp.0000436100.65983.10.