AUTHOR=Marino Maria Lucia , Rosa Alessandro C. , Finocchietti Marco , Bellini Arianna , Poggi Francesca R. , Massari Marco , Spila Alegiani Stefania , Masiero Lucia , Ricci Andrea , Bedeschi Gaia , Puoti Francesca , Cardillo Massimo , Pierobon Silvia , Nordio Maurizio , Ferroni Eliana , Zanforlini Martina , Piccolo Giuseppe , Leoni Olivia , Ledda Stefano , Carta Paolo , Garau Donatella , Lucenteforte Ersilia , Davoli Marina , Addis Antonio , Belleudi Valeria 

TITLE=Temporal and spatial variability of immunosuppressive therapies in transplant patients: An observational study in Italy

JOURNAL=Frontiers in Transplantation

VOLUME=Volume 1 - 2022

YEAR=2023

URL=https://www.frontiersin.org/journals/transplantation/articles/10.3389/frtra.2022.1060621

DOI=10.3389/frtra.2022.1060621

ISSN=2813-2440

ABSTRACT=In immunosuppression after transplantation, several multi-drug approaches are used, involving calcineurin inhibitors (CNI: tacrolimus-TAC or cyclosporine-CsA), antimetabolite (antiM), mammalian target of rapamycin inhibitors (mTORi) and corticosteroids. Data on immunosuppressive therapy by organ and its space-time variability are lacking.
An Italian multicentre observational cohort study was conducted using health information systems. Patients with incident transplant during 2009-19 and resident in four regions (Veneto, Lombardy, Lazio, Sardinia) were considered. The post-transplant immunosuppressive regimen was evaluated by organ, region and year.
The most dispensed regimen was triple drug therapy for kidney (TAC+antiM+corticosteroids=41.5%) and heart (CsA+antiM+corticosteroids=36.6%) and double drug therapy for liver recipients (TAC+corticosteroids=35.4%). Several differences among regions and years emerged with regard to agents and number of drugs used.  
High heterogeneity in immunosuppressive therapy post-transplant was found. Further studies are needed in order to investigate reasons of this variability and to evaluate the risk-benefit profile of treatment schemes adopted in the clinical practice.