title: Clopidogrel use as a risk factor for poor outcomes after kidney transplantation.
abstract: BACKGROUND
  Limited data are available on outcome implications of clopidogrel use before kidney transplantation.
  
  
  METHODS
  A novel dataset linking national transplant registry data with records from a large pharmacy claims clearinghouse (2005 to 2010) was examined to estimate risks of post-transplant death and graft failure associated with clopidogrel fills within 90 or more than 90 days before transplant.
  
  
  RESULTS
  Clopidogrel fills within 90 days of transplant were associated with 61% of increased relative mortality risk and 23% of increased graft failure risk. Risks were higher in those whose last clopidogrel fill was more than 90 days before transplantation (111% for death, 59% for graft loss). Adverse prognostic associations persisted among recipients of live and deceased donor allografts, older recipients, and those with diabetes or reported cardiovascular disease.
  
  
  CONCLUSIONS
  Clopidogrel use before kidney transplantation portends increased risks of post-transplant death and graft loss. Pharmacy claims may identify novel prognostic markers not currently captured in the transplant registry.
authors.affiliation: Division of Abdominal Organ Transplantation, Department of Surgery, Saint Louis University Medical Center, St. Louis, MO, USA; Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO, USA.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Williams
authors.affiliation: Division of Abdominal Organ Transplantation, Department of Surgery, Saint Louis University Medical Center, St. Louis, MO, USA; Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO, USA. Electronic address: jtuttlen@slu.edu.
authors.forename: Janet E
authors.initials: JE
authors.lastname: Tuttle-Newhall
authors.affiliation: Division of Abdominal Organ Transplantation, Department of Surgery, Saint Louis University Medical Center, St. Louis, MO, USA; Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Schnitzler
authors.affiliation: Department of Surgery, Dartmouth-Hitchcock Medical Center, Hanover, NH, USA.
authors.forename: Nino
authors.initials: N
authors.lastname: Dzebisashvili
authors.affiliation: Division of Abdominal Organ Transplantation, Department of Surgery, Saint Louis University Medical Center, St. Louis, MO, USA; Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO, USA.
authors.forename: Huiling
authors.initials: H
authors.lastname: Xiao
authors.affiliation: Department of Surgery, Dartmouth-Hitchcock Medical Center, Hanover, NH, USA.
authors.forename: David
authors.initials: D
authors.lastname: Axelrod
authors.affiliation: Division of Abdominal Organ Transplantation, Department of Surgery, Saint Louis University Medical Center, St. Louis, MO, USA.
authors.forename: Harveshp
authors.initials: H
authors.lastname: Mogal
authors.affiliation: Division of Abdominal Organ Transplantation, Department of Surgery, Saint Louis University Medical Center, St. Louis, MO, USA; Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO, USA; Division of Nephrology, Saint Louis University School of Medicine, St. Louis, MO, USA.
authors.forename: Krista L
authors.initials: KL
authors.lastname: Lentine
mesh_terms: D002318:Cardiovascular Diseases / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D000077144:Clopidogrel; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000139:chemically induced / Q000453:epidemiology*; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery*; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D011184:Postoperative Period; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D014019:Tissue Donors / Q000706:statistics & numerical data*; D014184:Transplantation, Homologous; D014481:United States / Q000453:epidemiology
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine
keywords: Clopidogrel; Death; Graft loss; Kidney transplantation; Outcomes; Pharmacy records