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. 

Related Articles

Continue Reading

“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.


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.