Pre‐existing diabetes is a risk factor for increased rates of cellular rejection after kidney transplantation: an observational cohort study

Abstract

Kidney allograft recipients with diabetes at transplantation should be counselled regarding their increased risk of cellular rejection but reassured regarding the lack of any adverse impact on short-to-medium term allograft function or survival.

Clinical Outcomes of ABO-Incompatible Kidney Transplantation in Patients with End-Stage Kidney Disease due to Diabetes Nephropathy

“…On the other hand, Baek et al [28] reported that there were no significant changes in the rates of rejection between diabetic and non-diabetic recipients. Some authors suggested that patients with diabetes were rendered susceptible to cellular rejection because of their significant risk of exacerbation of glycemic control after transplantation and that strict glycemic control might be important [4, 28]. In this study, glycemic control was relatively good because of the less than 7.0% HbA1c levels, which the Japan Diabetes Society recommends in order to avoid diabetic complications.…”

“…Previous reports have shown that hyperglycemia might be associated with an increased risk of acute allograft rejection in transplant recipients with diabetes [4]. Meanwhile, Clatworthy et al [26] suggested that B cell-related cytokines caused by rituximab administration were associated with higher rates of acute cellular rejection in rituximab-treated patients.…”

“…Johal et al [4] demonstrated an increased risk of developing cellular-, but not antibody-mediated, rejection among kidney transplant recipients with diabetes and revealed that diabetes at the time of kidney transplantation was independently associated with the risk of cellular rejection in a Cox regression model, adjusted for baseline variables. On the other hand, Baek et al [28] reported that there were no significant changes in the rates of rejection between diabetic and non-diabetic recipients.…”

“…Kidney transplant recipients with diabetes have a higher mortality than those without diabetes because of their elevated ­incidence of risk complications such as cardiovascular disease and infection [2, 3]. Moreover, a recent report demonstrated that pre-existing diabetes is a risk factor for increased rates of cellular rejection after kidney transplantation [4]. However, the data are clear that kidney transplantation is superior to remaining on dialysis for patients with diabetes [5].…”

Alteraciones del metabolismo de la glucosa en donante y receptor

“…41 La evidencia para eventos negativos relacionados al cambio por sirolimus está bien descrita. 42 Los artículos vinculan un incremento de riesgo de rechazo predominantemente celular en pacientes con DM pre o PTDM 43,44 y no se sabe si es una asociación bilateral, es decir, que más rechazo conlleve a incremento de esteroides o inversamente más DM2 o riesgo de DMPT predispone a esquemas de reducción rápida de esteroides que incrementan el riesgo de rechazo. 34,38,39 La literatura es controversial.…”