title: Race, Calcineurin Inhibitor Exposure, and Renal Function After Solid Organ Transplantation.
abstract: BACKGROUND
  Calcineurin-inhibitor (CNI)-induced nephrotoxicity frequently complicates transplantation. African-Americans are at a greater risk of renal failure than the general population. We investigated whether race was an effect modifier of the relationship between CNI exposure and kidney function after nonrenal solid organ transplantation.
  
  
  METHODS
  This is a retrospective cohort study of 1609 patients who underwent initial nonrenal solid organ transplantation between January 2000 and June 2012. A central repository administrative database was queried electronically for demographics, comorbidities, and serial levels of tacrolimus, cyclosporine, and serum creatinine. Predictors of interest were total drug exposure of tacrolimus and cyclosporine (area under the concentration-time curve) and self-reported race. The outcome of interest was cumulative change in estimated glomerular filtration rate (GFR).
  
  
  RESULTS
  There were 1109 patients treated with tacrolimus (271 African-Americans) and 500 patients treated with cyclosporine (113 African Americans). A decline in GFR over time was seen with total tacrolimus exposure (-1.3 mL/min/1.73 m(2) for every 5 ng/mL·year increase in tacrolimus) and total cyclosporine exposure (-1.1 mL/min/1.73 m(2) for every 50 ng/mL·year increase in cyclosporine). However, total CNI exposure effect on estimated GFR changes did not vary by race (P interaction was 0.9 for tacrolimus and 0.6 for cyclosporine).
  
  
  CONCLUSIONS
  Total CNI exposure is associated with worsening kidney function among patients with nonrenal solid organ transplantation. However, African-American patients are not more vulnerable to chronic CNI-induced nephrotoxicity when compared to white patients.
authors.affiliation: Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan, United States; Division of Nephrology, Henry Ford Hospital, Detroit, Michigan, United States. Electronic address: lyessay1@hfhs.org.
authors.forename: L
authors.initials: L
authors.lastname: Yessayan
authors.affiliation: Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan, United States.
authors.forename: A
authors.initials: A
authors.lastname: Shafiq
authors.affiliation: Heart and Vascular Institute, Henry Ford Hospital, Detroit, Michigan, United States.
authors.forename: E
authors.initials: E
authors.lastname: Peterson
authors.affiliation: Heart and Vascular Institute, Henry Ford Hospital, Detroit, Michigan, United States.
authors.forename: K
authors.initials: K
authors.lastname: Wells
authors.affiliation: Heart and Vascular Institute, Henry Ford Hospital, Detroit, Michigan, United States.
authors.forename: Y
authors.initials: Y
authors.lastname: Hu
authors.affiliation: Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan, United States; Heart and Vascular Institute, Henry Ford Hospital, Detroit, Michigan, United States.
authors.forename: L K
authors.initials: LK
authors.lastname: Williams
authors.affiliation: Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan, United States; Heart and Vascular Institute, Henry Ford Hospital, Detroit, Michigan, United States; Center for Health Services Research, Henry Ford Hospital, Detroit, Michigan, United States.
authors.forename: D
authors.initials: D
authors.lastname: Lanfear
mesh_terms: D065095:Calcineurin Inhibitors / Q000009:adverse effects*; D016572:Cyclosporine / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000187:drug effects*; D006084:Graft Rejection / Q000188:drug therapy; D006801:Humans; D015994:Incidence; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation; D044469:Racial Groups; D051437:Renal Insufficiency / Q000139:chemically induced* / Q000208:ethnology / Q000503:physiopathology; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016559:Tacrolimus / Q000009:adverse effects; D014481:United States / Q000453:epidemiology
chemical_list: D065095:Calcineurin Inhibitors; D016572:Cyclosporine; D016559:Tacrolimus