{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T17:47:56Z","timestamp":1789580876249,"version":"build-2803163510"},"reference-count":51,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2018,6,29]],"date-time":"2018-06-29T00:00:00Z","timestamp":1530230400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["R01DK102981"],"award-info":[{"award-number":["R01DK102981"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2018,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>While guidelines support metformin as a therapeutic option for diabetic patients with mild\u2010to\u2010moderate renal insufficiency, the frequency and outcomes of metformin use in kidney transplant recipients are not well described. We integrated national U.S. transplant registry data with records from a large pharmaceutical claims clearinghouse (2008\u20102015). Associations (adjusted hazard ratio, <jats:sub>95% LCL<\/jats:sub>aHR<jats:sub>95% UCL<\/jats:sub>) of diabetes regimens (with and excluding metformin) in the first year post\u2010transplant with patient and graft survival over the subsequent year were quantified by multivariate Cox regression, adjusted for recipient, donor, and transplant factors and propensity for metformin use. Among 14\u00a0144 recipients with pretransplant type 2 diabetes mellitus, 4.7% filled metformin in the first year post\u2010transplant; most also received diabetes comedications. Compared to those who received insulin\u2010based regimens without metformin, patients who received metformin were more likely to be female, have higher estimated glomerular filtration rates, and have undergone transplant more recently. Metformin\u2010based regimens were associated with significantly lower adjusted all\u2010cause (<jats:styled-content style=\"fixed-case\">aHR<\/jats:styled-content> <jats:sub>0.18<\/jats:sub>0.41<jats:sub>0.91<\/jats:sub>), malignancy\u2010related (<jats:styled-content style=\"fixed-case\">aHR<\/jats:styled-content> <jats:sub>0.45<\/jats:sub>0.45<jats:sub>0.99<\/jats:sub>), and infection\u2010related (<jats:styled-content style=\"fixed-case\">aHR<\/jats:styled-content> <jats:sub>0.12<\/jats:sub>0.32<jats:sub>0.85<\/jats:sub>) mortality, and nonsignificant trends toward lower cardiovascular mortality, graft failure, and acute rejection. No evidence of increased adverse graft or patient outcomes was noted. Use of metformin\u2010based diabetes treatment regimens may be safe in carefully selected kidney transplant recipients.<\/jats:p>","DOI":"10.1111\/ctr.13302","type":"journal-article","created":{"date-parts":[[2018,5,31]],"date-time":"2018-05-31T13:45:54Z","timestamp":1527774354000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":37,"title":["Metformin use in the first year after kidney transplant, correlates, and associated outcomes in diabetic transplant recipients: A retrospective analysis of integrated registry and pharmacy claims data"],"prefix":"10.1111","volume":"32","author":[{"given":"L. S.","family":"Vest","sequence":"first","affiliation":[{"name":"Saint Louis University  St. Louis MO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F. M.","family":"Koraishy","sequence":"additional","affiliation":[{"name":"Saint Louis University  St. Louis MO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Z.","family":"Zhang","sequence":"additional","affiliation":[{"name":"Saint Louis University  St. Louis MO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N. N.","family":"Lam","sequence":"additional","affiliation":[{"name":"University of Alberta  Edmonton AB Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. A.","family":"Schnitzler","sequence":"additional","affiliation":[{"name":"Saint Louis University  St. Louis MO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V. R.","family":"Dharnidharka","sequence":"additional","affiliation":[{"name":"Washington University  St. Louis MO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Axelrod","sequence":"additional","affiliation":[{"name":"Lahey Clinic  Burlington MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. S.","family":"Naik","sequence":"additional","affiliation":[{"name":"Univ Michigan  Ann Arbor MI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T. A.","family":"Alhamad","sequence":"additional","affiliation":[{"name":"Washington University  St. Louis MO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B. L.","family":"Kasiske","sequence":"additional","affiliation":[{"name":"Hennepin County  Minneapolis MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. P.","family":"Hess","sequence":"additional","affiliation":[{"name":"Symphony Health  Conshohocken PN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9423-4849","authenticated-orcid":false,"given":"K. L.","family":"Lentine","sequence":"additional","affiliation":[{"name":"Saint Louis University  St. Louis MO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,6,29]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc14-2441"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.7326\/M16-1860"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2012-001076"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007890-199710150-00008"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1600-6143.2003.00372.x"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2007111202"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.310.6972.83"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.TP.0000176482.63122.03"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1159\/000370034"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.4158\/EP.14.8.979"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000000454"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.12850"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.25.12.2359"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2006.01250.x"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gft536"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1517\/14740331003623218"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1611925"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(13)70208-0"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2011.03550.x"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2011.03921.x"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2014.19"},{"key":"e_1_2_8_23_1","unstructured":"Scientific Registry of Transplant Recipients.The living donor collective: srtr to launch a pilot project to create a registry of living donors.https:\/\/www.srtr.org\/news-publications\/news\/news-items\/news\/Accessed February 8 2017."},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0b013e318259407f"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0b013e318255f839"},{"key":"e_1_2_8_26_1","unstructured":"Communication FDS.FDA revises warnings regarding use of the diabetes medicine metformin in certain patients with reduced kidney function.2017."},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1038\/nature13270"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199508313330903"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/dom.12354"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmet.2016.05.011"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.298.17.2028"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(95)90638-X"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.89.3.991"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199602293340906"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0033411"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.1120781"},{"key":"e_1_2_8_37_1","doi-asserted-by":"publisher","DOI":"10.2174\/1871530315666150316124019"},{"key":"e_1_2_8_38_1","doi-asserted-by":"publisher","DOI":"10.1097\/SMJ.0b013e3181ce0e4d"},{"key":"e_1_2_8_39_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.22.6.925"},{"key":"e_1_2_8_40_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11255-008-9371-6"},{"key":"e_1_2_8_41_1","doi-asserted-by":"publisher","DOI":"10.1002\/j.1552-4604.1995.tb04033.x"},{"key":"e_1_2_8_42_1","first-page":"CD002967","article-title":"Risk of fatal and nonfatal lactic acidosis with metformin use in type 2 diabetes mellitus","author":"Salpeter SR","year":"2010","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_8_43_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2012.07.005"},{"key":"e_1_2_8_44_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc10-2361"},{"key":"e_1_2_8_45_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.ASN.0000085019.95339.F0"},{"key":"e_1_2_8_46_1","doi-asserted-by":"publisher","DOI":"10.1101\/sqb.2011.76.010819"},{"key":"e_1_2_8_47_1","doi-asserted-by":"publisher","DOI":"10.1038\/srep23975"},{"key":"e_1_2_8_48_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mce.2015.06.006"},{"key":"e_1_2_8_49_1","doi-asserted-by":"publisher","DOI":"10.4049\/jimmunol.1403088"},{"key":"e_1_2_8_50_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.14149"},{"key":"e_1_2_8_51_1","doi-asserted-by":"publisher","DOI":"10.7326\/M15-2650"},{"key":"e_1_2_8_52_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-016813"}],"container-title":["Clinical Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fctr.13302","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ctr.13302","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,15]],"date-time":"2023-09-15T20:02:46Z","timestamp":1694808166000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ctr.13302"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,6,29]]},"references-count":51,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2018,8]]}},"alternative-id":["10.1111\/ctr.13302"],"URL":"https:\/\/doi.org\/10.1111\/ctr.13302","archive":["Portico"],"relation":{},"ISSN":["0902-0063","1399-0012"],"issn-type":[{"value":"0902-0063","type":"print"},{"value":"1399-0012","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,6,29]]},"assertion":[{"value":"2018-05-13","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-06-29","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e13302"}}