Impact of Acute Rejection and New-Onset Diabetes on Long-Term Transplant Graft and Patient Survival

Abstract

Background and objectives: Development of new therapeutic strategies to improve long-term transplant outcomes requires improved understanding of the mechanisms by which these complications limit long-term transplant survival.Design, setting, participants, & measurements: The association of acute rejection and new-onset diabetes was determined in the first posttransplantation year with the outcomes of transplant failure from any cause, death-censored graft loss, and death with a functioning graft in 27,707 adult recipients of first kidney-only transplants, with graft survival of at least 1 yr, performed between 1995 and 2002 in the United States.Results: In multivariate analyses, patients who developed acute rejection or new-onset diabetes had a similar risk for transplant failure from any cause, but the mechanisms of transplant failure were different: Acute rejection was associated with death-censored graft loss but only weakly associated with death with a functioning graft. In contrast new-onset diabetes was not associated with death-censored graft loss but was associated with an increased risk for death with a functioning graft.Conclusions: Acute rejection and new-onset diabetes have a similar impact on long-term transplant survival but lead to transplant failure through different mechanisms. The mechanisms by which new-onset diabetes leads to transplant failure should be prospectively studied. Targeted therapeutic strategies to minimize the impact of various early posttransplantation complications may lead to improved long-term outcomes.

Association of Early Kidney Allograft Failure with Preformed IgA Antibodies to β 2-Glycoprotein I

“…However, early graft loss still remains a major cause of concern. 27 Although AR is associated with a 1.43-fold increase in graft loss (1.6-fold in DCGS), 28 at present, AR is not the most frequent cause of early graft loss. 29 In a series of 2381 consecutive deceased donor transplants, 4.6% of allografts (109) failed within 30 days of transplantation.…”

How do I manage hyperglycemia/post-transplant diabetes mellitus after allogeneic HSCT

“…47 The development of PTDM had a similar impact on the clinical outcome as acute rejection after kidney transplantation. 48 During an OGTT, each mmol/L increase in 2-h plasma glucose was associated with an increased risk of overall graft failure and cardiovascular mortality. 49 Early post-transplantation hyperglycemia is an independent risk factor for rehospitalization of non-diabetic kidney allograft recipients mainly owing to infectious diseases.…”

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“…Conversely, numerous studies have established acute rejection as an independent risk factor for graft loss. [48][49][50][51][52][53][54] In addition, patients who develop early rejection were at a higher risk of developing chronic allograft rejection. 55,56 In 1 study, the cause for graft failure was attributed to antibody-mediated rejection in one-half of patients requiring an indication biopsy.…”