Impact of Pretransplant and New-Onset Diabetes After Transplantation on the Risk of Major Adverse Cardiovascular Events in Kidney Transplant Recipients: A Population-based Cohort Study

Abstract

Original Clinical Science-General Background. Pretransplant diabetes and new-onset diabetes after transplant (NODAT) are known risk factors for vascular events after kidney transplantation, but the incidence and magnitude of the risk of major adverse cardiovascular events (MACE) and cardiac deaths remain uncertain in recent era. Methods. A population cohort study of kidney transplant recipients identified using data from linked administrative healthcare databases from Ontario, Canada. The incidence rates of MACE (expressed as events with 95% confidence interval [95% CI] per 1000 person-years were reported according to diabetes status of pretransplant diabetes, NODAT, or no diabetes. Extended Cox regression model was used to examine the association between diabetes status, MACE, and cardiac death. Results. Of 5248 recipients, 1973 (38%) had pretransplant diabetes, and 799 (15%) developed NODAT with a median follow-up of 5.5 y. The incidence rates (95% CI) of MACE for recipients with pretransplant diabetes, NODAT, and no diabetes between 1 and 3 y posttransplant were 38.1 (32.1-45.3), 12.6 (6.3-25.2), and 11.8 (9.2-15.0) per 1000 person-years, respectively. Compared with recipients with pretransplant diabetes, recipients with NODAT experienced a lower risk of MACE (adjusted hazard ratio, 0.59; 95% CI, 0.47-0.74) but not cardiac death (adjusted hazard ratio, 0.97; 95% CI, 0.61-1.55). The rate of MACE and cardiac death was lowest in patients without diabetes. Conclusions. Patients with pretransplant diabetes incur the greatest rate of MACE and cardiac deaths after transplantation. Having NODAT also bears high burden of vascular events compared with those without diabetes, but the magnitude of the increased rate remains lower than recipients with pretransplant diabetes.

Impact of Post-Transplant Diabetes Mellitus on Survival and Cardiovascular Events in Kidney Transplant Recipients

“…Post-transplant diabetes mellitus (PTDM), i.e., diabetes newly detected after transplantation, is a common complication (incidence of 10% to 25%) [2][3][4]. PTDM is associated with a poor prognosis after KT [2,5,6]. This can be explained by the fact that chronic hyperglycemia leads to micro-and macrovascular complications and death.…”

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

“…DM is known to be an important risk factor for chronic kidney disease and end-stage renal disease (ESRD) [ 3 ]. Indeed, almost 20–38% of patients undergoing kidney transplantation have DM [ 4 , 5 ]. However, a significant proportion of patients are known to develop DM after organ transplantation as well.…”

Global Epidemiology, Health Outcomes, and Treatment Options for Patients With Type 2 Diabetes and Kidney Failure

“…In this study, the incidence rates (95% CI) of CVD and all-cause mortality between 1 and 3 years post-transplant for recipients with PTDM were 6.6 (2.5–17.6) and 31.4 (20.5–48.2) per 1000 person-years, respectively. These compared with respective 7.1 (4.7-10.7) and 25.9 (21.2, 31.7) per 1000 person-years for recipients with pre-transplant diabetes, suggesting the importance of early screening and identification of recipients with PTDM ( 112 ). Predictably, the cost associated with each new case of PTDM is in excess of USD$21,000 by 2-years post-transplant ( 47 ), likely related to the diagnosis and treatment of common diabetes-related complications typically observed in the general population including hospitalizations for severe hyper- and hypoglycemia, ophthalmic complications, neurological complications, CVD, and peripheral vascular disease ( 113 – 115 ).…”

“…As patients with PTDM share common metabolic CVD risk factors with those with pre-transplant diabetes, the mechanistic pathways of abnormalities in insulin sensitivity and insulin secretion resulting in adverse CVD outcomes are likely to be similar (107)(108)(109)(110)(111). A recent population cohort study from Canada showed that kidney transplant recipients with PTDM were 40% less likely to experience major adverse cardiovascular events (MACE) post-transplant but had exhibited similarly high rates of all-cause and CVD mortality compared to those with pre-transplant diabetes (112). In this study, the incidence rates (95% CI) of CVD and all-cause mortality between 1 and 3 years post-transplant for recipients with PTDM were 6.6 (2.5-17.6) and 31.4 (20.5-48.2) per 1000 person-years, respectively.…”