Trends in the effects of pre‐transplant diabetes on mortality and cardiovascular events after kidney transplantation

Abstract

Aims/Introduction: It is not clear whether survival in kidney transplant recipients with pre-transplant diabetes has improved over the past decades. We compared the rates of mortality and major adverse cardiovascular events (MACE) after renal transplantation in patients with and without pre-transplant diabetes. Furthermore, we investigated whether transplant era and recipient age affected the association between diabetes status and adverse events. Materials and Methods: This retrospective cohort study included 691 patients who underwent renal transplantation between 1994 and 2016 at a single tertiary center. We compared the incidences of post-transplant mortality and four-point MACE in patients with and without pre-transplant diabetes using Kaplan-Meier analysis and the Cox proportional hazard model, and assessed the interactions between diabetes status and transplant era and recipient age. Results: Of 691 kidney recipients, 143 (20.7%) had pre-transplant diabetes. The mean follow-up duration was 94.5 months. Kaplan-Meier analysis showed that patients with pretransplant diabetes had higher incidences of post-transplant mortality and four-point MACE compared with those without pre-transplant diabetes (log-rank test, P < 0.001 for both). After adjusting for potential confounding factors, pre-transplant diabetes was associated with an increased risk of post-transplant mortality and four-point MACE (hazard ratio 1.90, 95% confidence interval 1.05-3.44, P = 0.034; and hazard ratio 1.75; 95% confidence interval 1.02-3.00, P = 0.043, respectively). The associations between pre-transplant diabetes status and all-cause mortality and four-point MACE were not affected by transplant era or recipient age. Conclusions: Pre-transplant diabetes remains a significant risk factor for mortality and four-point MACE in kidney transplant recipients.prevalence in Korea is similar to that in other Asian countries and the USA, which reported that 48% of the new ESRD cases in 2014 were attributable to diabetes 5 . Kidney transplantation is the preferred renal replacement therapy for ESRD patients with diabetes, because it is associated with better survival and quality of life compared with dialysis 6,7 . Recently, overall and cardiovascular mortality rates decreased markedly among patients with diabetes in developed countries in tandem with improvements in diabetes care and cardiovascular disease management [8][9][10] . Furthermore, the gap in † These authors contributed equally to this study.

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

“…Gaynor et al [6] suggested that the time taken for PTDM to negatively influence KT outcomes is considerable. In this context, we reported, in a cohort study, that pretransplant diabetes, which implies a longer exposure to chronic hyperglycemia than PTDM, was a risk factor for four-point MACE and posttransplant mortality [4]. The present study suggests that PTDM patients with long duration diabetes have a significantly elevated risk of CVD.…”

“…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].…”

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.…”

Abdominal Organ Transplantation: Noteworthy Literature in 2021

“…22 Pre-transplant diabetes was associated with an increased risk of postoperative mortality (HR 1.9, 95% CI 1.05-3.44) and MACEs (HR 1.75, 95% CI 1.02-3.00). 23 De Lima et al reported that cardiovascular events within a 12-month post-transplant period were associated with a 55% mortality rate. 22 Despite the strong evidence for increased risk of MACEs in KT recipients, preoperative cardiac risk reduction for the general population may be less effective for the KT population.…”

“…22 Pre-transplant diabetes was associated with an increased risk of postoperative mortality (HR 1.9, 95% CI 1.05–3.44) and MACEs (HR 1.75, 95% CI 1.02–3.00). 23 De Lima et al reported that cardiovascular events within a 12-month post-transplant period were associated with a 55% mortality rate. 22…”