Single-centre study of 628 adult, primary kidney transplant recipients showing no unfavourable effect of new-onset diabetes after transplant

Gaynor, Jeffrey J.; Ciancio, Gaetano; Guerra, Giselle; Sageshima, Junichiro; Hanson, Lois; Roth, David; Goldstein, Michael J.; Chen, Linda; Kupin, Warren; Mattiazzi, Adela; Tueros, Lissett; Flores, Sandra; Barba, Lilly; Lopez, Armando E.; Rivas, Jose Luis; Ruiz, Phillip; Vianna, Rodrigo; Burke, George W.

doi:10.1007/s00125-014-3428-0

Cited by 30 publications

(23 citation statements)

References 49 publications

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“…PTDM risk factors like elevated BMI and older age have also become more prevalent among wait‐listed patients . Perhaps, in part, because of these changes, recent studies have not uniformly demonstrated different patient and allograft outcomes in recipients with PTDM compared to those without diabetes in the United States . In contrast, a Norwegian single‐center study reported an independent association between PTDM and patient survival, but not with allograft survival; however, 90% of patients in this study were receiving cyclosporine A‐based immunosuppression .…”

Section: Introductioncontrasting

confidence: 60%

“…A detrimental effect of PTDM on patient survival has been previously reported . However, the three most recently published studies from the United States have not detected independent associations between PTDM and either allograft survival, all‐cause mortality, or DWFG . It has been speculated that these negative findings may have been due to the enrollment of only patients transplanted after the year 2000 when greater awareness and pro‐active treatment of PTDM may have reduced the consequences of this disease (the study by Pirsch et al .…”

Section: Discussionmentioning

confidence: 99%

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Long-term patient survival and kidney allograft survival in post-transplant diabetes mellitus: a single-center retrospective study

Dienemann

Fujii

et al. 2016

Transpl Int

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SUMMARYA decade ago, observations suggested that post-transplant diabetes mellitus (PTDM) was linked to allograft loss and shorter patient survival. Increasing awareness, improvements in care, and changes in the immunosuppressive regimen may have modified this association. Single-center analysis of 1990 (age>18; transplantation date 1996-2012) primary kidney recipients (KTR). Patients with <12 months follow-up were excluded. Diabetes was diagnosed according to ADA criteria and characterized as follows: No diabetes, PTDM in the first post-transplant year not treated with glucose-lowering medications (GLM) at 12 months, PTDM in the first post-transplant year treated with GLM at 12 months, and pretransplant diabetes. Cox proportional hazards models were used to examine the relationship of PTDM with allograft and patient survival. Mean follow-up time was 6.8 years for allograft survival and 7.4 years for patient survival. PTDM treated with medication at year one was not associated with allograft survival (HR 1.28, 95% CI 0.97-1.69), but was significantly associated with overall mortality and death with functioning graft (DWFG) (HR overall: 1.81, 95% CI 1.36-2.39; HR DWFG: 1.59 95% CI 1.05-2.38). In this cohort, KTR with PTDM being treated with glucose-lowering medication at 12 months experienced significantly shorter overall survival and survival with functioning graft.

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Section: Introductioncontrasting

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Long-term patient survival and kidney allograft survival in post-transplant diabetes mellitus: a single-center retrospective study

Dienemann

Fujii

et al. 2016

Transpl Int

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“…We found no relationship between perioperative glycaemia and AR, supporting the supremacy of preventing rejection rather than modifying diabetogenic immunosuppressant regimens as the primary strategy to prevent PTDM [18]. Although PTDM has been associated with poorer outcomes in early studies [1], our results at 12 months are consistent with more recent findings that outcomes of those with PTDM are similar to those without diabetes [19, 20], although this is limited by short follow-up and small numbers.…”

Section: Discussionsupporting

confidence: 87%

The Effect of Different Glycaemic States on Renal Transplant Outcomes

Sheu

Depczynski

O’Sullivan

et al. 2016

Journal of Diabetes Research

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Background. Optimal glycaemic targets following transplantation are unknown. Understanding the impact of DM and posttransplant diabetes mellitus (PTDM) may improve patient and graft survival in transplant recipients. Aim. To determine the perioperative and one-year outcomes after renal transplantation and whether these outcomes are affected by preexisting DM, PTDM, or glycaemia during transplant admission. Method. Adult recipients of renal transplants from a single centre over 5.5 years were retrospectively reviewed. Measured outcomes during transplant admission included glycaemia and complications (infective complications, acute rejection, and return to dialysis) and, at 12 months, glycaemic control and complications (cardiovascular complication, graft failure). Results. Of 148 patients analysed, 29 (19.6%) had DM and 27 (18.2%) developed PTDM. Following transplantation, glucose levels were higher in patients with DM and PTDM. DM patients had a longer hospital stay, had more infections, and were more likely return to dialysis. PTDM patients had increased rates of acute rejection and return to dialysis. At 1 year after transplant, there were more cardiovascular complications in DM patients compared to those without DM. Conclusions. Compared to patients without DM, patients with DM or PTDM are more likely to suffer from complications perioperatively and at 12 months. Perioperative glycaemia is associated with graft function and may be a modifiable risk.

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“…22 Current investigations indeed have pointed toward a reduced risk of NODAT on major adverse events, presumably due to more thorough blood glucose monitoring posttransplant. 23,24 In line with these more recent reports, our data could not determine any association of prediabetes with reduced transplant function or graft and patient outcomes. Hyperglycemia as caused by overt diabetes can lead to insulin resistance, dyslipidemia, platelet activation, or hypertension.…”

Section: Discussionsupporting

confidence: 71%

Untitled

Tillmann

Radtke²,

Rump³

et al. 2017

Exp Clin Transplant

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Objectives: This study investigated the effect of prediabetes in long-term deceased-donor renal transplant recipients regarding graft survival, graft function, and evolution of new-onset diabetes after transplant compared with a control group of graft recipients with normal glucose tolerance test results. Materials and Methods: This was a follow-up trial of 187 deceased-donor renal transplant recipients. Based on oral glucose tolerance test results, the cohort was divided into groups A and B, comprising individuals with normal glucose metabolism (n = 130, 69.9%) and individuals with prediabetes (n = 56, 30.1%). Data are shown as means ± standard errors. Results: Both groups showed similar total transplant survival (116.8 ± 5.4 vs 114.5 ± 7.4 mo; P = .742) and transplant survival measured since oral glucose tolerance test (58.5 ± 1.4 vs 59.5 ± 1.9 mo; P = .990, Mantel-Cox P = .943). Univariate and multivariate Cox regression analyses showed no association of prediabetes with graft loss. Transplant function changes were similar between cohorts (-3 ± 1 vs -5 ± 2 mL/min/1.73 m 2 body surface area, using the Chronic Kidney Disease Epidemiology Collaboration formula; P = .538). At 5-year follow-up, recipients with prediabetes had higher hemoglobin A1c than controls (5.99% ± 0.10% vs 5.67% ± 0.04%; P = .002). Prediabetes was associated with a 4.5-fold increased hazard of new-onset diabetes after transplant (P = .021). Conclusions: Prediabetes was associated with a 4.5-fold higher hazard ratio for new-onset diabetes after transplant but not with reduced graft function or survival.

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Single-centre study of 628 adult, primary kidney transplant recipients showing no unfavourable effect of new-onset diabetes after transplant

Abstract: Less-than-expected post-NODAT risk for graft loss and death may exist in the current climate of tighter glucose monitoring post transplant.

Cited by 30 publications

References 49 publications

Long-term patient survival and kidney allograft survival in post-transplant diabetes mellitus: a single-center retrospective study

Long-term patient survival and kidney allograft survival in post-transplant diabetes mellitus: a single-center retrospective study

The Effect of Different Glycaemic States on Renal Transplant Outcomes

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