{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T23:56:52Z","timestamp":1777420612304,"version":"3.51.4"},"reference-count":17,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2018,9,20]],"date-time":"2018-09-20T00:00:00Z","timestamp":1537401600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ann Pharmacother"],"published-print":{"date-parts":[[2019,3]]},"abstract":"<jats:p>Background: Biologic agents inhibiting the tumor necrosis factor \u03b1 pathway (TNF\u03b1-Is) are used to treat systemic inflammatory diseases. The best management of these agents after renal transplantation is unknown. Objective: Evaluate peritransplant use of TNF\u03b1-Is and associated outcomes. Methods: Retrospective, single-center study of adult renal-transplant-recipients (RTRs) transplanted between 1\/1\/1998-12\/31\/2017, who received TNF\u03b1-Is for inflammatory disease prior to transplant. Qualifying patients were divided into 2 cohorts: patients who resumed TNF\u03b1-Is after transplant and those who did not. Outcomes were evaluated. Results: A total of 5256 renal transplants occurred in the study window; 14 patients met inclusion criteria. Primary indication for TNF\u03b1-I was Crohn\u2019s-disease (CD; 57.1%). Infliximab was utilized most frequently (50%). Seven RTRs resumed TNF\u03b1-I posttransplant; mean time to resumption of 10.6\u00b14.35 months (median=6 months), 85.7% for CD. Immunosuppression was modified in 2 patients (28.6%) in response to restarting TNF\u03b1-I therapy. Seven RTRs did not resume TNF\u03b1-Is following transplant; the majority of these had rheumatic diseases. There was no significant difference in time to first bacterial or fungal infection, rejection, or patient survival between the 2 groups. Last measured estimated glomerular-filtration-rate was similar between groups (TNF\u03b1-I: 41 \u00b1 14.2 vs 48.6 \u00b1 8.6, P = 0.25). No patient had cytomegalovirus infection; however, 42.8% of each cohort had documented BK virus infection. Malignancy occurred more frequently in the cohort that resumed TNF\u03b1-Is (42.8% vs 14.3%, P = 0.24); however, this was not statistically significant. Conclusion and Relevance: TNF\u03b1-I therapy prior to renal-transplant is relatively uncommon. The decision to continue therapy after transplant must balance risks of infection and malignancy against inflammatory disease recurrence. A multidisciplinary treatment approach is necessary as use of TNF\u03b1-I affects immunosuppressive management and appears to affect transplant outcomes. Future studies are needed to further clarify the role of TNF\u03b1-I therapy use in RTRs with inflammatory disorders focusing on its correlation with both BK and malignancy.<\/jats:p>","DOI":"10.1177\/1060028018802814","type":"journal-article","created":{"date-parts":[[2018,9,20]],"date-time":"2018-09-20T11:22:19Z","timestamp":1537442539000},"page":"268-275","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":13,"title":["Management of Tumor Necrosis Factor \u03b1 Inhibitor Therapy After Renal Transplantation: A Comparative Analysis and Associated Outcomes"],"prefix":"10.1177","volume":"53","author":[{"given":"Caroline S.","family":"Quinn","sequence":"first","affiliation":[{"name":"University of Wisconsin Hospital and Clinics, Madison WI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6088-9727","authenticated-orcid":false,"given":"Margaret R.","family":"Jorgenson","sequence":"additional","affiliation":[{"name":"University of Wisconsin Hospital and Clinics, Madison WI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1196-5110","authenticated-orcid":false,"given":"Jillian L.","family":"Descourouez","sequence":"additional","affiliation":[{"name":"University of Wisconsin Hospital and Clinics, Madison WI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brenda L.","family":"Muth","sequence":"additional","affiliation":[{"name":"University of Wisconsin School of Medicine and Public Health, Madison, WI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brad C.","family":"Astor","sequence":"additional","affiliation":[{"name":"University of Wisconsin School of Medicine and Public Health, Madison, WI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Didier A.","family":"Mandelbrot","sequence":"additional","affiliation":[{"name":"University of Wisconsin School of Medicine and Public Health, Madison, WI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2018,9,20]]},"reference":[{"key":"bibr1-1060028018802814","doi-asserted-by":"publisher","DOI":"10.1016\/j.cyto.2016.08.014"},{"key":"bibr2-1060028018802814","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa041884"},{"key":"bibr3-1060028018802814","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2010.137422"},{"key":"bibr4-1060028018802814","doi-asserted-by":"publisher","DOI":"10.1185\/03007995.2015.1011778"},{"key":"bibr5-1060028018802814","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000005108"},{"key":"bibr6-1060028018802814","unstructured":"StataCorp. 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