The decision to resume tumor necrosis factor α inhibitor (TNFα-I) therapy after renal transplantation should be based on an analysis that takes into account the risk of infection and malignancy weighed against the possibility of inflammatory disease recurrence, according to a study published in Annals of Pharmacotherapy.

The retrospective, single-center study included adult renal-transplant-recipients (RTRs) who received TNFα-I therapy for the treatment of an inflammatory disease prior to their transplantation. Various study outcomes were assessed and comparisons between patients who resumed TNFα-I therapy after transplantation and those who did not were made.

Of the 5256 patients who received a renal transplant in the study window (1/1/1998 – 12/31/2017), 14 met inclusion criteria. Crohn’s disease (CD) was the primary indication for TNFα-I use in 57.1% of the study’s patients and infliximab was the most frequently used TNFα-I (50% of patients).

Results of the study found that TNFα-I therapy was resumed in 7 RTRs posttransplant, with 85.7% of them being treated for CD. The average time to resumption of TNFα-I therapy was 10.6±4.35 months (median: 6 months). “Immunosuppression was modified in 2 patients (28.6%) in response to restarting TNFα-I therapy,” the study authors added. The majority of the 7 RTRs who did not reinitiate TNFα-I therapy posttransplant were found to have rheumatic diseases. 

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“There was no significant difference in time to first bacterial or fungal infection, rejection, or patient survival between the 2 groups,” the authors reported. “Last measured estimated glomerular-filtration-rate was similar between groups (TNFα-I: 41 ± 14.2 vs 48.6 ± 8.6, P=.25).”

In each study group, 42.8% of patients had documented BK virus infection, however, zero patients had cytomegalovirus. Malignancy occurred in 42.8% of patients who resumed TNFα-I therapy compared with 14.3% of patients who did not, however, the results were not statistically significant (P=.24).

It is relatively uncommon for patients to receive TNFα-I therapy before renal transplantation. “A multidisciplinary treatment approach is necessary as use of TNFα-I affects immunosuppressive management and appears to affect transplant outcomes,” the authors concluded.

Reference:

Quinn SC, Jorgenson MR, Descourouez, JL. Management of Tumor Necrosis Factor α Inhibitor Therapy After Renal Transplantation: A Comparative Analysis and Associated Outcomes. Annals of Pharmacotherapy. 2018. doi.org/10.1177/1060028018802814.