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Supplementary Material for: The Clinical Manifestation of Immunosuppressive Therapy as a Tool to Improve Immune Monitoring in Renal Transplant Recipients

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posted on 2023-05-25, 06:11 authored by Andres F. Yepes Perez, Natália P. de Almeida, Laurent Callot, Robert Malmstrom, Mehmet Caner, Anders Bredahl Kock, Juan Andres Riquelme, Laura Coroneo
Introduction: Metrics for post-transplant immune monitoring to prevent over or under immunosuppression in renal transplant recipients (RTRs) are lacking. Methods: We surveyed 132 RTRs, 38 in the first year post transplant and 94 >1 year post-transplant, to study the clinical expression of immunosuppressive therapy. A questionnaire administered to these RTRs was divided into physical (Q physical) and mental (Q mental) symptoms. Results: In multivariable models for the association between the calculated Q physical and Q mental scores and different clinical and biochemical variables in the 38 RTRs who filled out the questionnaire 130 times during the first year post-transplant, it was found that mycophenolic acid (MPA) and prednisone use increased the mean Q physical score by 0.59 (95% CI 0.21-0.98, p=0.002) and 0.53 (95% CI 0.26-0.81, p=0.00), respectively, while MPA use increased the mean Q mental score by 0.72 (95% CI 0.31-1.12, p=0.001). Among the 94 RTRs who each completed the questionnaire only once, the odds for the mean Q mental score to be above the median value were more than 3 times higher for RTRs treated vs. non-treated with MPA (OR 3.38, 95% CI 1.1-10.3, p=0.03). MPA-treated RTRs had higher mean scores for questions related to sleep disorders (1.83±1.06 vs. 1.32±0.67 for not treated, p=0.037), to difficulty falling asleep (1.72±1.11 vs. 1.16±0.5, p=0.02), and to depression and anxiety. Conclusion: We concluded that prednisone and MPA use are associated with an increased Q physical and Q mental scores in RTRs. Routine monitoring of physical and mental status of RTRs should be implemented to improve the diagnosis of overimmunosuppression. Dose reduction or discontinuation of MPA should be considered in RTRs who report sleep disorders, depression and anxiety.

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