Abstract
BACKGROUND: The impact of new immunosuppressive strategies to prevent graft rejection on prescribing patterns is poorly documented. The objective of this study was to describe immunosuppressive medication use and survival outcomes in patients undergoing kidney transplantation in France between 2009 and 2020. METHODS: This retrospective cohort study was performed using data from the French national healthcare database. All adult patients undergoing kidney transplantation between 2009 and 2020 were identified, and followed from transplantation until study end, death or graft failure. All immunosuppressive drug deliveries from pharmacies were documented. Survival and death-censored graft failure were estimated using Kaplan-Meier analysis. RESULTS: Thirty four thousand six hundred kidney transplantation patients were eligible. Median follow-up duration was 4.0 years [IQR: 1.6-7.0 years]. Five-year survival probability was 0.890 [0.885-0.895], and death-censored graft survival was 0.850 [0.844-0.856]. Overall survival, but not graft survival was age-dependent. Calcineurin inhibitors were delivered to 29,573 patients (91.3%), antimetabolites to 29,318 (90.5%), corticosteroids to 28,536 (88.1%), mTOR inhibitors to 5231 (16.1%) and belatacept to 1272 (3.9%). The use of tacrolimus, everolimus and belatacept increased over time, while the use of corticosteroids, ciclosporin and sirolimus declined. Immunosuppressive treatment was maintained by 22,963 patients (76.5%) throughout follow-up. CONCLUSIONS: In this comprehensive study of kidney transplant recipients in France, we observed high rates of overall patient and graft survival. Over the study period, immunosuppressive treatment patterns were relatively stable and dominated by the use of calcineurin inhibitors. These results provide important insights into the state of post-transplant care and the potential implications of increased availability of innovative therapies.