Suphamai Bunnapradist

University of California, Los Angeles, Los Angeles, California, United States

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Publications (153)550.31 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: An increasing number of patients 80 years and older have received a kidney transplant in the United States, but their outcomes are not well described. Using Organ Procurement and Transplantation Network/United Network of Organ Sharing data, outcomes of recipients 80 years and older were evaluated. Thirty-one thousand one hundred seventy-nine elderly recipients defined by age 60 years and older receiving kidney transplants from 2000 to 2008 were stratified: ages 60 to 69 years (n=24,877), 70 to 79 years (n=6,103), and 80 years and older (n=199). Cox regression models were used to compare patient, graft, and death-censored graft survival. The majority of recipients 80 years and older was male (82.9%), white (87.9%), and less likely to have diabetes or coronary artery disease. More expanded criteria donor (ECD) but fewer living donor transplants were performed among 80 years and older compared with those younger than 80 years. Perioperative mortality, defined as death within 30 days posttransplant, was rare (60-69 years: 1.4%; 70-79 years: 1.5%; and ≥80 years: 2.5%) but tended to be higher among those 80 years and older compared with recipients 60 to 69 years (hazard ratio [HR] 1.67; 95% confidence interval [CI] 0.69-4.05). At 2 years, survival was lower for 80 years and older (73%; HR 2.42; 95% CI 1.91-3.06) and 70 to 79 years (86%; HR: 1.42; 95% CI: 1.34-1.51) compared with recipients 60 to 69 years (89%). There was a greater risk of graft loss among recipients 80 years and older compared with those 60 to 69 years (HR 1.78; 95% CI 1.42-2.23); however, no difference in death-censored graft survival was observed (0.89; 0.57-1.39). Among recipients 80 years and older, no difference in survival was observed between standard criteria donor and ECD recipients. Although perioperative mortality was uncommon among elderly recipients (1.5%), a trend toward higher perioperative mortality was observed in recipients 80 years and older. There was no difference in survival among standard criteria donor and ECD recipients.
    Transplantation 11/2010; 90(9):974-9. · 3.78 Impact Factor
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    ABSTRACT: Living donor kidney transplantation (LDKT) in type 1 diabetic recipients (T1DM) may be followed by a pancreas after living donor kidney (PALK). The impact of the PALK is largely unknown. Adult T1DM living donor kidney recipients (1997-2007) listed for pancreas transplantation were divided into those who subsequently received pancreas transplantation and those who did not (living donor kidney transplant alone [LDKA]). Outcomes were compared. A sub-analysis was performed in recipients with at least one yr of kidney graft survival and limiting PALK to those who underwent pancreas transplantation in the first year. Of 4554 recipients, 23% received PALK. PALK had more favorable baseline characteristics. At the end of eight yr, we found significantly superior patient (85% vs. 75%) and kidney graft survival (75% vs. 62%) in PALK group. The adjusted hazard ratios of PALK (LDKA as reference) were 0.65 (95%CI: 0.52-0.81) for death and 0.63 (0.54-0.76) for renal graft loss. In sub-group analysis, there was a trend toward decreased death in PALK (HR = 0.78: 0.57-1.07). In conclusion, only 23% of those wait-listed received a pancreas with patient and kidney survival superior to LDKA. Pancreas transplant in the first year after kidney transplant was associated with a trend toward better long-term patient survival.
    Clinical Transplantation 11/2010; 24(6):812-20. · 1.63 Impact Factor
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    ABSTRACT: Cardiovascular disease (CVD) is the leading cause of death in renal transplant recipients with a functioning allograft. Modification of CVD risk factors may, therefore, decrease overall mortality in this patient population. We studied renal transplant recipients within an integrated healthcare system (IHS) that uses case management and electronic health records to determine mortality from CVD. We retrospectively collected data on all renal transplant recipients over a 10-year period. The primary endpoint was death with graft function (DWGF). Cardiovascular events were used as secondary endpoints. We determined the cause of death and collected laboratory data. The data were analyzed using Student's t test for continuous data, chi square for categorical data, and multivariate logistic regression. Survival was determined using the Kaplan-Meier product-limit method. Death from "other" causes accounted for 29%. This was followed by CVD (24%), infection (16%), and malignancy (12%). The most common "other" causes were diabetes mellitus and end-stage renal disease. Overall, lower hemoglobin, uncontrolled blood pressure, and lower albumin levels were associated with DWGF. There were 184 cardiovascular events in total. Low-density lipid levels were lower in the group with cardiovascular events and DWGF. The use of antihypertensive and antihyperlipidemic agents was similar between the two groups with the exception of diuretics, which were used more often in the DWGF group. There was a low rate of DWGF because of CVD within this IHS. It is possible that coordinated care within an IHS leads to improved cardiovascular mortality.
    Transplantation 11/2010; 91(2):225-30. · 3.78 Impact Factor
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    ABSTRACT: Our objectives are to examine the incidence of new-onset diabetes mellitus after transplant (NODAT) and to identify its risk factors in pediatric liver transplant recipients using the Organ Procurement and Transplant Network/United Network for Organ Sharing database. Between July 2004 and December 2008, a total of 1214 children (2-20 years old) received their first liver transplant alone, and had at least 1 follow-up report of posttransplant diabetic status. Among these, 1161 recipients were identified as not having diabetes mellitus before transplant. Risk factors for NODAT were examined using classification and regression tree and multivariate Cox regression analysis. Diabetes mellitus was newly reported in 10.1% of the 1161 recipients over the median follow-up time of 770 days. The cumulative incidences of NODAT at 1, 2, and 3 years after transplant were 5.9%, 8.3%, and 11.2%, respectively. More than 50% of recipients with cystic fibrosis developed NODAT. In recipients without cystic fibrosis, independent risk factors for NODAT included increased recipient age (compared to 2-5 years, hazard ratio = 3.09 for 5-13 years, p = 0.02; 7.14 for ≥13 years, p < 0.001), African American race (1.97, p = 0.003), and primary diagnosis of primary sclerosing cholangitis (2.24, p = 0.02) and acute hepatic necrosis (1.89, p = 0.04). In conclusion, NODAT occurred in one-tenth of pediatric liver transplant recipients in the United States during the median follow-up of 2 years. Some of the risk factors for NODAT in pediatric liver transplant recipients are similar to those reported in other solid organ transplants. Underlying liver disease of cystic fibrosis, primary sclerosing cholangitis, and acute hepatic necrosis are independent risk factors for NODAT in pediatric liver transplant recipients.
    Liver Transplantation 11/2010; 16(11):1249-56. · 3.94 Impact Factor
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    Suphamai Bunnapradist, Gabriel M Danovitch
    Clinical Journal of the American Society of Nephrology 10/2010; 5(11):1910-1. · 5.07 Impact Factor
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    ABSTRACT: Diabetes and acute rejection are major contributors to morbidity and mortality in kidney transplant recipients. Immunosuppressive medications decrease acute rejection, but increase the frequency of new-onset diabetes after transplant. Our objective was to investigate the joint associations of diabetes (pretransplant diabetes and new-onset diabetes after transplant) and acute rejection with transplant outcomes in a recent transplant cohort. Historical cohort study. 37,448 recipients (age ≥ 18 years; 2004-2007) surviving with a functioning transplant for longer than 1 year were identified in the Organ Procurement and Transplant Network/United Network for Organ Sharing (OPTN/UNOS) database as of May 22, 2009. Recipients were stratified into 6 mutually exclusive groups according to status of diabetes and acute rejection at 1 year: group 1, neither (reference; n = 20,964); group 2, new-onset diabetes alone (n = 2,140); group 3, pretransplant diabetes alone (n = 10,730); group 4, acute rejection alone (n = 2,282); group 5, new-onset diabetes and acute rejection (n = 361); and group 6, pretransplant diabetes and acute rejection (n = 1,061). Analyses were adjusted for other recipient, donor, and transplant characteristics. OUTCOMES MEASUREMENTS: Multivariate Cox regression analysis of time to transplant failure (overall and death censored) and mortality (all-cause and cardiovascular). Median follow-up after 1 year was 548 days (25th-75th percentiles, 334-752 days). During this time, there were 3,047 outcomes of overall transplant failure. New-onset diabetes alone (group 2) was not associated significantly with any study outcomes. Groups 3-6 were associated with higher overall transplant failure risk. However, only groups 4-6 were associated with higher death-censored transplant failure risk. Group 3, 4, and 6 were associated with higher all-cause mortality risk, whereas only groups 3 and 6 were associated with higher cardiovascular mortality risk. Potential information bias with exposure, covariable, or outcome misclassification; relatively short follow-up. Pretransplant diabetes is the major predictor of all-cause and cardiovascular mortality, and acute rejection during the first year is the major predictor of death-censored transplant failure in kidney recipients surviving with a functioning transplant for at least 1 year. The influence of new-onset diabetes on long-term outcomes needs further observation.
    American Journal of Kidney Diseases 10/2010; 56(6):1127-39. · 5.29 Impact Factor
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    ABSTRACT: We evaluated the effectiveness of induction therapy on transplant outcomes during 2004-2007 in the United States. We retrospectively reviewed OPTN/UNOS registry and selected kidney pediatric (<21-yr) recipients that received no induction (NoIND), IL-2RA, or rabbit anti-THY and were discharged with a triple drug immunosuppressive maintenance regimen, including steroids. Of 2932 recipients, 20%, 36%, and 43% were in NoIND, THY, and IL-2RA groups, respectively. The majority received tacrolimus (88%) and MMF (89%) at discharge. There was no association of induction with the risk of acute rejection even after adjusting for known cofounders. Compared to NoIND, IL2-RA, but not THY, had a modest decrease (3%) in absolute rate of graft loss and was associated with a risk reduction ratio of 0.51 (95% CI, 0.31-0.84) in one-yr graft loss. At three yr, no induction agent was associated with decreased graft loss. In conclusion, induction agents were used in 80% of pediatric kidney recipients discharged with a triple drug immunosuppressive maintenance regimen between 2004-2007 in the United States. Neither THY nor IL-2RA was associated with reduced rejection episodes. The use of induction therapy was not associated with improvement in three-yr graft survival.
    Pediatric Transplantation 09/2010; 14(6):770-8. · 1.50 Impact Factor
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    ABSTRACT: The objectives of this study are to investigate the impact of cytomegalovirus (CMV) donor (D)/recipient (R) serostatus on kidney transplant outcomes in recipients who received CMV prophylaxis and to investigate the association of individual antiviral agents (acyclovir, ganciclovir, and valganciclovir) with outcomes in high-risk recipients (D+/R-). By using the Organ Procurement and Transplant Network/United Network for Organ Sharing database, 25,058 deceased donor kidney recipients (≥ 18 years, 2004-2008) who received CMV prophylaxis were stratified into four groups: D+/R+ (11,875), D-/R+ (6046), D+/R- (4555), and D-/R- (2582). The impact of CMV D/R serostatus on acute rejection (6 months and 1 year posttransplant) and long-term outcomes of death-censored graft failure and mortality were compared. The impact of the individual antiviral agent on long-term outcome was further evaluated in the high-risk group (D+/R-). In multivariate analysis, CMV D/R status was not associated with acute rejection. Compared with D-/R-, D+/R- was associated with an increased risk for death-censored graft failure (hazard ratio=1.28, P=0.01), all-cause mortality(hazard ratio=1.36, P=0.003), and mortality because of viral infection (hazard ratio=8.36, P=0.04). In the D+/R- group, valganciclovir usage was associated with a decreased risk for death-censored graft failure (hazard ratio=0.65, P=0.007) and mortality because of viral infection (hazard ratio=0.22, P=0.03) compared with ganciclovir usage. CMV mismatch (D+/R-) was no longer a risk factor for acute rejection in kidney recipients who received antiviral prophylaxis but was still an independent risk factor for death-censored graft failure, all-cause mortality, and viral infection-related mortality.
    Transplantation 09/2010; 90(10):1091-8. · 3.78 Impact Factor
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    ABSTRACT: The objectives of this study are to examine the incidence of new-onset diabetes mellitus (NODM) and to identify its risk factors in adult heart recipients using the Organ Procurement and Transplant Network/United Network of Organ Sharing database. Between July 2004 and December 2007, 4972 adults (aged 18 years or older) received their first heart transplant alone, and had at least one follow-up report of posttransplant diabetic status. Among these, 3763 recipients were identified as not having diabetes mellitus pretransplant. Risk factors for NODM were examined using multivariate Cox regression analysis using the time to NODM diagnosis as a time-varying endpoint. NODM was reported in 1075 (28.6%) of the 3763 recipients without pretransplant diabetes (median follow-up time, 713 days). Independent risk factors for development of NODM included older age (hazard ratio=1.20 for age >or=50 years vs. <50, P=0. 01), non-white race (0.70 for white vs. non-white, P<0.0001), higher body mass index (BMI) (1.55 for BMI >or=25 vs. <25, P<0.0001), ischemic heart disease (1.24, P<0.0001), recipient cytomegalovirus positivity (1.16, P=0.003), tobacco use (1.16, P=0.02), tacrolimus use at discharge (1.85 for tacrolimus vs. cyclosporine use, P<0.0001), and use of steroids at discharge (2.59 for steroid use vs. none, P=0.008). NODM is common and occurs in more than a quarter of heart recipients during the median follow-up period of 2 years. Risk factors for NODM after heart transplant are similar to those reported in other solid organ transplants. Some of these factors, such as BMI and immunosuppressive regimen, are potentially modifiable.
    Transplantation 06/2010; 89(12):1526-32. · 3.78 Impact Factor
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    ABSTRACT: Preexisting hepatitis C virus (HCV) infection is implicated in diminished patient and graft survivals in renal transplant recipients. The impact of HCV infection on patient and graft survival in simultaneous pancreas-kidney transplantations is unclear. We evaluated the effect of preexisting HCV infection on patient and graft survival in simultaneous pancreas-kidney transplant (SPKT) recipients in the United States. Using the Organ Procurement and Transplant Network/United Network for Organ Sharing database as of March 2009, adult primary SPKT recipients transplanted from 1995 to 2008 were studied. We stratified recipients based on pretransplant HCV status as HCV positive (HCV+) or HCV negative (HCV-). Overall kidney graft, pancreas graft, and patient survival were compared. A total of 10,809 adults received primary SPKT, of which 350 (3.2%) were HCV+. Less than 2% of the HCV+ recipients received organs from HCV+ donors. There were no significant differences in baseline donor and recipient characteristics between groups. Rates of acute kidney rejection at 1 year were similar: 22.9% for HCV+ and 23.0% for HCV- recipients (P=0.49). There was no difference in serum creatinine between groups up to 3 years. After controlling for confounding factors, HCV positivity was not associated with worsened overall kidney graft (hazard ratio [HR] 0.80, 95% confidence interval [CI] 0.61-1.03), pancreas graft (HR 0.80, 95% CI 0.63-1.00), or patient survival (HR 0.78, 95% CI 0.56-1.08). Only 3.2% of SPKT recipients had preexisting HCV infection. Preexisting HCV infection had no significant impact on kidney graft, pancreas graft, or patient survival.
    Transplantation 05/2010; 90(1):61-7. · 3.78 Impact Factor
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    ABSTRACT: One of the alternative options to simultaneous pancreas-kidney transplantation (SPKT) for type I diabetics with renal failure is sequential transplant of a living donor kidney followed by a deceased donor pancreas transplant (pancreas after living donor kidney transplant [PALK]). We retrospectively compared the outcomes of SPKT versus PALK. Adults (age 18-59 years) with type I diabetes who were waitlisted for kidney-pancreas and received a SPKT or PALK between 2000 and 2007 were studied. We compared patient, kidney graft, and pancreas graft survival. Multivariate analysis was performed, and the results were expressed as hazard ratios (HRs) of graft loss and death of PALK, with SPKT as a reference. Of 11,966 patients who received a kidney transplant, 807 received a PALK and 5580 received a SPKT. Median time to pancreas from kidney transplant was 336 (25%-75%: 185-602 days) days. Average hospital stay for SPKT recipients was 13.2+/-15 days, whereas for PALK recipients was 5.7+/-4 days and 9.5+/-8 days for kidney and pancreas transplants, respectively. After controlling for confounding factors, patients receiving PALK had better patient survival (HR 0.52; 95% confidence interval [CI] 0.39-0.70) and kidney survival (HR 0.48; 95% CI 0.39-0.60) but worse pancreas survival (HR 1.37; 95% CI 1.16-1.62) compared with SPKT. Among those who were waitlisted for a kidney-pancreas transplant, 53% received a kidney-pancreas transplant. Of those who received a kidney-pancreas transplant, 87% patients underwent SPKT and 13% underwent PALK. PALK was associated with better kidney graft and patient survival compared with SPKT. We found an inferior pancreas graft survival and longer total transplant hospitalization in PALK.
    Transplantation 04/2010; 89(12):1496-503. · 3.78 Impact Factor
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    ABSTRACT: OBJECTIVE.: To analyze the risk factors for new-onset diabetes mellitus (NODM) in liver transplant recipients using the Organ Procurement and Transplant Network/United Network for Organ Sharing database. METHODS.: Among 20,172 primary liver recipients (age > or =18 years) transplanted between July 2004 and December 2008 in Organ Procurement and Transplant Network/United Network for Organ Sharing databases, 15,463 recipients without pretransplant diabetes were identified. Risk factors for NODM were examined using multivariate Cox regression analysis. RESULTS.: NODM was reported in 26.4% of recipients (median follow-up, 685 days). Independent predictors of NODM development included recipient age (> or = 50 vs. <50 years, hazard ratio [HR]=1.241), African American race (HR=1.147), body mass index (> or = 25 vs. <25, HR=1.186), hepatitis C (HR=1.155), recipient cirrhosis history (HR=1.107), donor age (> or = 60 vs. <60 year, HR=1.152), diabetic donor (HR=1.151), tacrolimus (tacrolimus vs. cyclosporine, HR=1.236), and steroid at discharge (HR=1.594). Living donor transplant (HR=0.628) and induction therapy (HR=0.816) were associated with a decreased risk of NODM. CONCLUSION.: The incidence of NODM was 26.4% in liver recipients with a median follow-up time of 685 days. Identified risk factors for NODM in liver transplantation were similar to that in kidney transplantation. Some of the identified factors are potentially modifiable, including obesity and the choice of immunosuppressive regimens.
    Transplantation 04/2010; 89(9):1134-40. · 3.78 Impact Factor
  • Christine Lau, Suphamai Bunnapradist
    Nephrology Times. 03/2010; 3(4):10-11.
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    ABSTRACT: BACKGROUND.: In kidney transplant, obesity was reported to be associated with increased posttransplant complications and worse survival outcomes. The impact of obesity in simultaneous pancreas-kidney (SPK) transplant is less known. METHODS.: Using Organ Procurement Transplantation Network/United Network for Organ Sharing data as of August 2008, we included all adults (>18 years) type 1 diabetic SPK recipients between years 2000 and 2007 with a pretransplant body mass index (BMI) of 18.5 to 40 kg/m. The cohort was divided in three groups: normal (BMI 18.5-24.9 kg/m, reference group), overweight (BMI 25-29.9 kg/m), and obese (BMI 30-40 kg/m). Covariate-adjusted relative risk of a combination of posttransplant complications and patient, pancreas and kidney allograft outcomes were evaluated. RESULTS.: Of 5725 recipients, 56%, 33%, and 11% were in normal, overweight, and obese groups, respectively. Overweight and obese recipients were older, had a higher percent of coronary artery disease, and private health insurance coverage. Overall posttransplant complications were higher in obese group (35.7% vs. 28.6%) when compared with normal BMI group. They were mainly due to increased delayed kidney graft function (11.8% vs. 7.4%), 1-year kidney acute rejection (17.0% vs. 12.1%), and pancreas graft thrombosis (2.6% vs. 1.3%). After adjusting for possible confounders, the odds ratios for overall transplant complications were 1.03 (95% confidence interval [CI]: 0.90-1.17) for overweight and 1.38 (95% CI: 1.15-1.68) for obese. Obesity, but not overweight, was associated with patient death (hazard ratio [HR]: 1.35; 95% CI: 1.00-1.81), pancreas graft loss (HR: 1.41; 95% CI: 1.17-1.69), and kidney graft loss (HR: 1.33; 95% CI: 1.05-1.67) at 3 years. The higher rates of death and graft failure in the first 30 days posttransplant mostly accounted for the 3-year survival differences. CONCLUSION.: Obesity in SPK recipients was associated with increased risk of posttransplant complications, pancreas and kidney graft loss, and patient death.
    Transplantation 02/2010; 89(9):1117-25. · 3.78 Impact Factor
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    ABSTRACT: The objective of this study was to identify the risk factors for new-onset diabetes mellitus (NODM) after kidney transplant in pediatric renal transplant recipients using Organ Procurement Transplant Network/United Network of Organ Sharing database. A total of 2726 nondiabetic primary kidney transplant recipients (age 2-20 years, transplanted between July 2004 and December 2007) in the Organ Procurement Transplant Network/United Network of Organ Sharing database as of August 2008 with at least one follow-up report were included. We examined the risk factors for NODM using multivariate Cox regression analysis using the time to NODM reported as a time-varying endpoint. In recipients with functional graft at 1 year after transplant, the graft survivals during subsequent 24 months were compared according to the presence of NODM within first year of transplant. NODM was reported in 4.6% (median follow-up time: 693 days). Independent risk factors for NODM included increased age (>10 years vs. <10 years, hazard ratio [HR]=2.143, P=0.015), abnormal body mass index percentile (<5% or >85% vs. 5%-85%, HR=1.697, P=0.01), and steroid use at discharge (yes vs. no, HR=3.573, P=0.03). Living donor transplant was associated with a decreased risk of NODM (living vs. deceased, HR=0.629, P=0.05). NODM within first year of transplant was not associated with inferior graft survival during subsequent 24 months. Some of the identified risk factors for NODM are potentially modifiable, including abnormal body mass index percentile and the use of steroid. Prospective clinical trials are needed to assess whether modifying these risk factors will prevent NODM.
    Transplantation 02/2010; 89(4):434-9. · 3.78 Impact Factor
  • American Journal of Kidney Diseases - AMER J KIDNEY DIS. 01/2010; 55(4).
  • J. Gill, M. Sampaio, Y. W. Cho, S. Bunnapradist
    Transplantation 01/2010; 90. · 3.78 Impact Factor
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    Marcelo S Sampaio, Aditya Kadiyala, Jagbir Gill, Suphamai Bunnapradist
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    ABSTRACT: Alemtuzumab use has been increasing in kidney transplantation. We aimed to compare posttransplantation outcomes between alemtuzumab and interleukin-2 receptor antibodies (IL-2RA) in living donor kidney transplant recipients in the United States. Organ Procurement Transplant Network/United Network of Organ Sharing data, as of August 2007, were used to identify all living donor kidney transplants performed in adults in the United States from 2003 to 2006 where induction therapy with alemtuzumab or IL-2RA (daclizumab or basiliximab) was used. Primary outcomes included incidence of acute rejection, graft survival, and patient survival. One thousand nine hundred thirteen recipients received alemtuzumab and 7011 received IL-2RA. There were few significant differences in baseline characteristics. The incidence of acute rejection at discharge was lower in the alemtuzumab group, when compared with that in the IL-2RA group (0.8% vs. 4.4%, respectively, P<0.001), but it was similar by 1 year posttransplant (9.8% vs. 11%, respectively). After adjusting for confounding factors, those in alemtuzumab group had a higher adjusted relative risk of graft loss (hazard ratios 1.23, 95% CI 1.03-1.48) in 4 years. Patient survival was comparable between the study groups. A higher rate of acute rejection and graft failure was seen in the recipients who used triple regimen (calcineurin-mycophenolate-steroid) in association with alemtuzumab. The incidence of acute rejection at discharge was lower with alemtuzumab but was comparable with IL-2RA up to 1 year posttransplant. There was no difference in patient survival, but the risk of graft loss among patients who received alemtuzumab was higher compared with those who received IL-2RA induction.
    Transplantation 10/2009; 88(7):904-10. · 3.78 Impact Factor
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    ABSTRACT: Risk of new-onset diabetes after transplant (NODAT) is well characterized for adults but much less understood in pediatric transplant. This study examines the incidence and risk factors of NODAT in pediatric renal transplant patients. The incidence of NODAT over the first 3 years after transplant was examined with the United States Renal Data System data for primary renal transplant recipients (ages 0-21 years, transplanted between 1995 and 2004) with Medicare primary. Patients had no evidence of diabetes before transplant. We estimated the cumulative incidence rate and used Cox proportional hazards regression to identify the risk factors for NODAT. Propensity scores were calculated for immunosuppression choice to adjust for potential confounding factors. Two thousand one hundred sixty-eight recipients with valid immunosuppression records and without pretransplant evidence of diabetes were included. Unadjusted, cumulative NODAT incidence at 3 years posttransplant was 7.1%. Significant factors for increased risk of NODAT included cytomegalovirus D+/R- serostatus (adjusted hazard ratio [aHR]=1.60), age 13 to 18 years (aHR=2.18), age 19 to 21 years (aHR=2.60), body mass index more than or equal to 30 kg/m (aHR=2.17), and use of tacrolimus (aHR=1.51). We failed to find any significant relationships between NODAT and graft failure or death. Although the incidence of NODAT among patients aged 0 to 21 years is lower than that for adult patients, it is higher than suggested by earlier research and may represent an increase over time. The lack of association between NODAT and graft or failure death has important implications for posttransplant care. A clearer understanding of risk factors can help guide posttransplant monitoring and clinical decision making.
    Transplantation 09/2009; 88(3):367-73. · 3.78 Impact Factor
  • Suphamai Bunnapradist, Flavio Vincenti
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    ABSTRACT: In participants of the CONVERT trial, which enrolled recipients of kidney transplants, conversion of immunosuppressive therapy from calcineurin inhibitors to sirolimus did not improve renal function. More importantly, the intervention was detrimental among patients with impaired kidney function and/or proteinuria. Sirolimus conversion resulted, however, in lower rates of malignancy.
    Nature Reviews Nephrology 08/2009; 5(7):371-3. · 7.94 Impact Factor

Publication Stats

2k Citations
550.31 Total Impact Points

Institutions

  • 2004–2014
    • University of California, Los Angeles
      • • Division of Nephrology
      • • Department of Medicine
      Los Angeles, California, United States
  • 2013
    • University of Colorado
      • Division of Renal Diseases and Hypertension
      Denver, CO, United States
  • 2007–2012
    • Harbor-UCLA Medical Center
      Torrance, California, United States
  • 2003–2012
    • Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center
      • Department of Medicine
      Torrance, California, United States
    • University of Cincinnati
      • College of Medicine
      Cincinnati, OH, United States
  • 2011
    • St. Paul's Hospital
      Saskatoon, Saskatchewan, Canada
  • 2009
    • Johns Hopkins Medicine
      Baltimore, Maryland, United States
  • 2007–2009
    • Saint Louis University
      • Department of Internal Medicine
      Saint Louis, MI, United States
  • 2005–2007
    • Washington University in St. Louis
      • Department of Surgery
      San Luis, Missouri, United States
  • 2000–2007
    • Cedars-Sinai Medical Center
      • Cedars Sinai Medical Center
      Los Angeles, CA, United States
  • 2002–2006
    • Ospedale Maggiore Carlo Alberto Pizzardi di Bologna
      Bolonia, Emilia-Romagna, Italy
  • 2003–2005
    • Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico
      • Nephrology and Dialysis
      Milano, Lombardy, Italy
    • Children's Hospital Los Angeles
      • Division of Medical Genetics
      Los Angeles, California, United States
  • 2002–2005
    • University of Southern California
      • • Keck School of Medicine
      • • Division of Gastrointestinal and Liver Diseases
      Los Angeles, California, United States