Impact of diabetes mellitus developing after kidney transplantation on patient mortality and graft survival: a meta-analysis of adjusted data

Abstract

Background Post-transplant diabetes mellitus (PTDM) occurs in 10–30% of kidney transplant recipients. However, its impact on mortality and graft survival is still ambiguous. Therefore, the current study aimed to analyze if PTDM increases mortality and graft failure by pooling multivariable-adjusted data from individual studies. Methods PubMed, Embase, and CENTRAL, and Google Scholar were searched for studies comparing mortality and graft failure between PTDM and non-diabetic patients. Multivariable-adjusted hazard ratios (HR) were pooled in a random-effects model. Results Fourteen retrospective studies comparing 9872 PTDM patients with 65,327 non-diabetics were included. On pooled analysis, we noted a statistically significant increase in the risk of all-cause mortality in patients with PTDM as compared to non-diabetics (HR: 1.67 95% CI 1.43, 1.94 I2 = 57% p < 0.00001). The meta-analysis also indicated a statistically significant increase in the risk of graft failure in patients with PTDM as compared to non-diabetics (HR: 1.35 95% CI 1.15, 1.58 I2 = 78% p = 0.0002). Results were stable on sensitivity analysis. There was no evidence of publication bias on funnel plots. Conclusion Kidney transplant patients developing PTDM have a 67% increased risk of all-cause mortality and a 35% increased risk of graft failure. Further studies are needed to determine the exact cause of increased mortality and the mechanism involved in graft failure.

Clinical outcomes of posttransplantation diabetes mellitus in kidney transplantation recipients: a nationwide population-based cohort study in Korea

“…Maintaining proper glucose levels with insulin rather than oral antidiabetic medications means that it is highly likely that glucose is not well controlled. As there have already been many reports that high blood glucose levels are related to cardiovascular events 6,34 , adverse graft outcomes 35,36 , and infection 9 , the present study's results can be understood in the same context.…”

Sweet and simple as syrup: A review and guidance for use of novel antihyperglycemic agents for post‐transplant diabetes mellitus and type 2 diabetes mellitus after kidney transplantation

“…While the incidence of PTDM is high at 15%, new data shows that it is declining due to changing paradigms in titration of CNI and corticosteroids 7,8 . Early and accurate detection is vital as diabetes mellitus and PTDM are associated with increased mortality and morbidity 9–16 …”

“…7,8 Early and accurate detection is vital as diabetes mellitus and PTDM are associated with increased mortality and morbidity. [9][10][11][12][13][14][15][16] Management of PTDM is similar to that of T2DM in the general population with a focus on strict glycemic control and reduction in the occurrence of diabetes-related complications. Several new antihyperglycemic agents have been introduced since 2005: GLP1RA, DPP4i, and SGLT2i.…”

Sodium-glucose cotransporter 2 inhibitors and cardiorenal outcomes in kidney transplantation

“…As many as 45% of the patients can develop impaired fasting glucose 1 week posttransplant and 24% can develop post-transplant DM three years post-transplant [6]. Diabetes in KTR is associated with increased cardiovascular complications and all-cause mortality post-transplant [7]. Calcineurin inhibitors and corticosteroids are contributors to the development and worsening of DM, dyslipidemia, and post-KT hypertension [7,8].…”

“…Diabetes in KTR is associated with increased cardiovascular complications and all-cause mortality post-transplant [7]. Calcineurin inhibitors and corticosteroids are contributors to the development and worsening of DM, dyslipidemia, and post-KT hypertension [7,8]. Post-transplant treatment is associated with weight gain, which further contributes to the development of comorbidities such as hypertension, PTDM, and metabolic syndrome [9,10].…”