New onset diabetes after kidney transplantation is associated with increased mortality—A retrospective cohort study

Cooper, Lisa; Oz, N.; Fishman, Gad; Shohat, Tamar; Rahamimov, Ruth; E, Mor; Green, H.; Grossman, Alon

doi:10.1002/dmrr.2920

Cited by 25 publications

(20 citation statements)

References 23 publications

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“…In contrast to our findings, several studies have reported that diabetes and hyperlipidemia are independent risk factors associated with graft loss in renal transplant recipients [20,[30][31][32][33][34][35][36][37]. Differences between earlier studies and our study regarding diabetes and hyperlipidemia may reflect differences in patient populations and definitions of diabetes and hyperlipidemia used in the studies or limitations of the NIS database, since it was not possible to differentiate between patients who developed these conditions before and after transplantation.…”

Section: Discussioncontrasting

confidence: 99%

Risk factors for complications and graft failure in kidney transplant patients with sepsis

Syu

Lin

et al. 2018

Bosn J of Basic Med Sci

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Immunosuppressive therapies decreased the incidence of acute kidney rejection after kidney transplantation, but also increased the risk of infections and sepsis. This study aimed to identify the risk factors associated with complications and/or graft failure in kidney transplant patients with sepsis. A total of 14,658 kidney transplant patients with sepsis, identified in the National Inpatient Sample (NIS) database (data from 2005–2014), were included in the study and classified into three groups: patients without complications or graft failure/dialysis (Group 1), patients with complications only (Group 2), and patients with complications and graft failure/dialysis (Group 3). Multinomial logistic regression analyses were conducted to evaluate factors associated with kidney transplant recipients. Multivariate analysis showed that, compared to Group 1, patients from Group 2 or Group 3 were more likely to be Black and to have cytomegalovirus infection, coagulopathy, and glomerulonephritis (p ≤ 0.041). Also, Group 2 was more likely to have herpes simplex virus infection, and Group 3 was more likely to have hepatitis C infection and peripheral vascular disorders, compared to Group 1 (p ≤ 0.002). In addition, patients from Group 3 were more likely to be Black and to have hepatitis C infection, peripheral vascular disorders, coagulopathy, and hypertension compared to Group 2 (p ≤ 0.039). Age and female gender were associated with lower odds of complications after kidney transplantation regardless of graft rejection/dialysis (p ≤ 0.049). Hyperlipidemia and diabetes decreased the chance of complications and graft failure/dialysis after kidney transplant (p < 0.001). In conclusion, the study highlights that black race, male gender, and specific comorbidities can increase the risk of complications and graft failure in kidney transplant patients with sepsis.

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Section: Discussioncontrasting

confidence: 99%

Risk factors for complications and graft failure in kidney transplant patients with sepsis

Syu

Lin

et al. 2018

Bosn J of Basic Med Sci

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“…[1][2][3] NODAT is associated with elevated risks of morbidity (eg,, infection, cardiovascular disease, and chronic kidney disease) and mortality. 3,4 Current known risk factors of NODAT include older age, family history, obesity, hepatitis C virus infection, and immunosuppressive agents. A meta-analysis including 19 studies with 3611 patients receiving kidney, liver, or heart transplant demonstrated that most (74%) of the cases of NODAT could be explained by immunosuppression.…”

Section: Introductionmentioning

confidence: 99%

The tacrolimus-induced glucose homeostasis imbalance in terms of the liver: From bench to bedside

Ling

Huang

Han

et al. 2020

American Journal of Transplantation

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Tacrolimus (TAC), the mainstay of maintenance immunosuppressive agents, plays a crucial role in new‐onset diabetes after transplant (NODAT). Previous studies investigating the diabetogenic effects of TAC have focused on the β cells of islets. In this study, we found that TAC contributed to NODAT through directly affecting hepatic metabolic homeostasis. In mice, TAC‐induced hypoglycemia rather than hyperglycemia during starvation via suppressing gluconeogenetic genes, suggesting the limitation of fasting blood glucose in the diagnosis of NODAT. In addition, TAC caused hepatic insulin resistance and triglyceride accumulation through insulin receptor substrate (IRS)2/AKT and sterol regulatory element binding protein (SREBP1) signaling, respectively. Furthermore, we found a pivotal role of CREB‐regulated transcription coactivator 2 (CRTC2) in TAC‐induced metabolic disorders. The restoration of hepatic CRTC2 alleviated the metabolic disorders through its downstream molecules (eg, PCK1, IRS2, and SREBP1). Consistent with the findings from bench, low CRTC2 expression in graft hepatocytes was an independent risk factor for NODAT (odds ratio = 2.692, P = .023, n = 135). Integrating grafts’ CRTC2 score into the clinical model could significantly increase the predictive capacity (areas under the receiver operating characteristic curve: 0.71 vs 0.79, P = .048). Taken together, in addition to its impact on pancreatic cells, TAC induces “hematogenous diabetes” via CRTC2 signaling. Liver‐targeted management may be of help to prevent or heal TAC‐associated diabetes.

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“…The incidence of diabetes in all children is rising, and it is also not known if rates are greater among those transplanted compared with the general pediatric population. Furthermore, the strong association of diabetes with mortality is known in adults [6][7][8], but there are conflicting results among children [4].…”

Section: Original Articlementioning

confidence: 99%

Incidence of new-onset diabetes mellitus and association with mortality in childhood solid organ transplant recipients: a population-based study

Chanchlani

Kim

Dixon

et al. 2018

Nephrology Dialysis Transplantation

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New onset diabetes after kidney transplantation is associated with increased mortality—A retrospective cohort study

Abstract: New onset diabetes in kidney transplanted patients is associated with increased mortality compared with kidney transplanted patients without NODAT.

Cited by 25 publications

References 23 publications

Risk factors for complications and graft failure in kidney transplant patients with sepsis

Risk factors for complications and graft failure in kidney transplant patients with sepsis

The tacrolimus-induced glucose homeostasis imbalance in terms of the liver: From bench to bedside

Incidence of new-onset diabetes mellitus and association with mortality in childhood solid organ transplant recipients: a population-based study

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