The Effect of Posttransplantation Diabetes Mellitus on the Prognosis of Transplantation: a Prospective Cohort Study

Abstract

Background: Posttransplantation diabetes mellitus (PTDM) constitutes one of the most important complications associated with kidney transplantation and is associated with significant morbidity and mortality. Methods: This study was a single-centred prospective observational study that included 310 consecutive renal transplant recipients. The primary end point was graft failure, including death-censored graft failure and mortality. The secondary endpoints include estimated glomerular filtration rate (eGFR) at 12 months and adverse events after transplantation. The prevalence rate of PTDM and relevant risk factors for PTDM were also explored. Results: The incidence of PTDM was 16.4% within one year. Death-censored graft loss rate differed significantly between recipients without PTDM and those with PTDM(0.77% versus 12%, p<0.001). Compared with non-PTDM group, the mean eGFR was significantly lower in the PTDM group(70.55±20.54 ml/min·1.73 m² versus 63.04±21.92 ml/min·1.73 m², P=0.03). Additionally, compared with the other group, the PTDM group was more easily infected by bacteria(16.2% versus 40%, P<0.001). Multi-factor analysis indicated that higher preoperative fasting plasma glucose (FPG), increased age and use of tacrolimus after transplantation were independent risk factors for PTDM. Conclusion: The incidence rate of PTDM is 16.4% 1 year after surgery. Our study suggests that patients with PTDM are at higher risk of death-censored graft loss and bacterial infection, and worse kidney function. Independent risk factors of PTDM include preoperative FPG level, increased age, and tacrolimus. The PTDM group is more vulnerable to worse graft function, postoperative graft loss and bacterial infection.