Comparing survival outcomes for kidney transplant recipients with pre‐existing diabetes versus those who develop post‐transplantation diabetes

Hussain, Azm Iftikhar; Culliford, Alice; Phagura, Nuvreen; Evison, Felicity; Gallier, Suzy; Sharif, Adnan

doi:10.1111/dme.14707

Cited by 3 publications

(5 citation statements)

References 37 publications

(60 reference statements)

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“…PTDM is associated with overall graft loss [ 13 ], cardiovascular events [ 8 , 14 ] and all-cause mortality [ 8 ], while microvascular complications are less studied [ 4 ] and patient-reported outcomes are scarce. Some studies observe no association with patient/graft survival [ 15 , 16 ], but this discrepancy might be influenced by heterogenous cohorts, diagnostic criteria or methodological differences. Importantly, the association of prediabetes with mortality and cardiovascular events should be appreciated [ 9 ].…”

Section: Opinion Statement 2: Be Aware Of Long-term Consequences Of P...mentioning

confidence: 99%

International consensus on post-transplantation diabetes mellitus

Sharif,

Chakkera,

de Vries

et al. 2024

Nephrology Dialysis Transplantation

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Post-transplantation diabetes mellitus (PTDM) remains a leading complication after solid organ transplantation. Previous international PTDM consensus meetings in 2003 and 2013 provided standardized frameworks to reduce heterogeneity in diagnosis, risk stratification and management. However, the last decade has seen significant advancements in our PTDM knowledge complemented by rapidly changing treatment algorithms for management of diabetes in the general population. In view of these developments, and to ensure reduced variation in clinical practice, a 3rd international PTDM Consensus Meeting was planned and held between 6–8 May 2022 in Vienna, Austria involving global delegates with PTDM expertise to update the previous report. This update includes opinion statements concerning optimal diagnostic tools, recognition of prediabetes (impaired fasting glucose and/or impaired glucose tolerance), new mechanistic insights, immunosuppression modification, evidence-based strategies to prevent PTDM, treatment hierarchy for incorporating novel glucose-lowering agents and suggestions for the future direction of PTDM research to address unmet needs. Due to the paucity of good quality evidence, consensus meeting participants agreed making GRADE recommendations would be flawed Although kidney-allograft centric, we suggest these opinion statements can be appraised by the transplantation community for implementation across different solid organ transplant cohorts. Acknowledging the paucity of published literature, this personal viewpoint reflects consensus expert opinion. Attaining evidence is desirable to ensure establishment of optimized care for any solid organ transplant recipient at risk of, or who develops, PTDM as we strive to improve long-term outcomes.

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Section: Opinion Statement 2: Be Aware Of Long-term Consequences Of P...mentioning

confidence: 99%

International consensus on post-transplantation diabetes mellitus

Sharif,

Chakkera,

de Vries

et al. 2024

Nephrology Dialysis Transplantation

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“…[18][19][20] However, this may be down to different follow-up periods. For example, Hussain et al 18 observed the risk of PTD impacting mortality after kidney transplantation is associated with cumulative longevity of exposure. Data are limited when it comes to association between PTD and graft survival, which is less clear for death-censored versus overall graft survival.…”

Section: Improving Clinical Outcomes With Ptdmentioning

confidence: 99%

“…For example, a recently published report demonstrated 29.2% of PTD patients were on metformin treatment after kidney transplantation in a single-center UK analysis. 18…”

Section: Insulin Sensitizing Strategiesmentioning

confidence: 99%

“…PTD increases patient mortality in some studies [15][16][17] but not in others. [18][19][20] However, this may be down to different follow-up periods. For example, Hussain et al 18 observed the risk of PTD impacting mortality after kidney transplantation is associated with cumulative longevity of exposure.…”

Section: Improving Clinical Outcomes With Ptdmentioning

confidence: 99%

“…For example, a recently published report demonstrated 29.2% of PTD patients were on metformin treatment after kidney transplantation in a single-center UK analysis. 18 Concerns about the renal restrictions associated with metformin use likely contributes to metformin underutilization. Although concerns about lactic acidosis secondary to metformin use alone at lower levels of renal function may be misplaced, 77,78 it must be appreciated that commonly used concomitant therapy (eg, renin angiotensin system agents and diuretics) may exacerbate risk.…”

Section: Metforminmentioning

confidence: 99%

See 2 more Smart Citations

Interventions Against Posttransplantation Diabetes: A Scientific Rationale for Treatment Hierarchy Based on Literature Review

Sharif

2022

Transplantation

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Posttransplant diabetes (PTD) is a common medical complication after solid organ transplantation. Because of adverse outcomes associated with its development and detrimental impact on long-term survival, strategies to prevent or manage PTD are critically important but remain underresearched. Treatment hierarchies of antidiabetic therapies in the general population are currently being revolutionized based on cardiovascular outcome trials, providing evidence-based rationale for optimization of medical management. However, opportunities for improving medical management of PTD are challenged by 2 important considerations: (1) translating clinical evidence data from the general population to underresearched solid organ transplant cohorts and (2) targeting treatment based on primary underlying PTD pathophysiology. In this article, the aim is to provide an overview of PTD treatment options from a new angle. Rationalized by a consideration of underlying PTD pathophysiological defects, which are heterogeneous among diverse transplant patient cohorts, a critical appraisal of the published literature and summary of current research in progress will be reviewed. The aim is to update transplant professionals regarding medical management of PTD from a new perspective tailored therapeutic intervention based on individualized characteristics. As the gap in clinical evidence between management of PTD versus type 2 diabetes widens, it is imperative for the transplant community to bridge this gap with targeted clinical trials to ensure we optimize outcomes for solid organ transplant recipients who are at risk or develop PTD. This necessary clinical research should help efforts to improve long-term outcomes for solid transplant patients from both a patient and graft survival perspective.

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Post-Transplant Diabetes Mellitus in Kidney-Transplanted Patients: Related Factors and Impact on Long-Term Outcome

Alfieri,

Campioli,

Fiorina

et al. 2024

Nutrients

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This study aimed to investigate the prevalence and determinants of glucose metabolism abnormalities and their impact on long-term clinical outcomes in kidney transplant recipients (KTxps). A retrospective analysis of 832 KTxps (2004–2020) was performed. Patients were assessed at 1 (T1), 6 (T6), and 12 (T12) months post-transplantation and clinically followed for an average of 103 ± 60 months. At T6, 484 patients underwent an oral glucose tolerance test for the diagnosis of alterations in glucose metabolism (AMG+) or post-transplant diabetes mellitus (PTDM+). The prevalence of pre-transplant diabetes was 6.2%, with 22.4% of PTDM+ within the 1st year. Patients with AMG were older and exhibited altered lipid profiles, higher body mass index, and increased inflammatory indices. Age at transplantation, lipid profile, and inflammatory status were significant determinants of PTDM. Graft loss was unaffected by glucose metabolism alterations. Survival analysis demonstrated significantly worse long-term survival for KTxps with diabetes (pre- and PTDM+, p = 0.04). In a comparison of the ND and PTDM+ groups, no significant differences in death with a functioning graft were found. The AMG+ group exhibited worse survival (p < 0.001) than AMG−, even after excluding patients with diabetes mellitus. Future randomized controlled trials are necessary to delve deeper into this subject, specifically examining the effects of new antidiabetic treatments.

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Comparing survival outcomes for kidney transplant recipients with pre‐existing diabetes versus those who develop post‐transplantation diabetes

Cited by 3 publications

References 37 publications

International consensus on post-transplantation diabetes mellitus

International consensus on post-transplantation diabetes mellitus

Interventions Against Posttransplantation Diabetes: A Scientific Rationale for Treatment Hierarchy Based on Literature Review

Post-Transplant Diabetes Mellitus in Kidney-Transplanted Patients: Related Factors and Impact on Long-Term Outcome

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