Posttransplant diabetes mellitus and acute rejection: impact on kidney transplant outcome

Transplantation. 2008 Feb 15;85(3):338-43. doi: 10.1097/TP.0b013e318160ee42.

Abstract

Background: The benefits (e.g., low acute rejection [AR] rate) vs. the long-term risk of each immunosuppressive protocol may determine the protocol's value.

Methods: We studied the long-term impact of new-onset posttransplant diabetes (PTDM) and/or AR in 1,487 adult, primary transplant, nondiabetic recipients. Per Cox regression, donor source, AR, and PTDM were independent risk factors for graft loss (each, p<.0001). Recipients were subdivided by donor source and into these 4 groups: no AR, no PTDM [n=857]; no AR, PTDM [n=134]; > or =1 AR, no PTDM [n=403]; > or =1 AR, PTDM [n=93].

Results: There was a significant difference between groups in 15-yr actuarial graft survival (GS) and death-censored (DC) GS (p<.0001). Importantly, > or =1 AR had more impact on 15-yr GS and DC GS than did PTDM; the worst outcome was for those having both AR and PTDM. In separate analyses, we censored those with >1 AR; and then only compared those developing AR or PTDM in the first year. The results were similar--the AR (no PTDM) group did worse than the PTDM (no AR) group (p<.001).

Conclusions: Determining long-term risks associated with immunosuppressive protocols is important for treating future patients. Our data suggests that 15-year actuarial outcome (GS and DC GS) is worse for those developing AR than for those developing PTDM.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Acute Disease
  • Adult
  • Diabetes Mellitus / drug therapy
  • Diabetes Mellitus / epidemiology
  • Diabetes Mellitus / immunology*
  • Diabetes Mellitus / surgery*
  • Female
  • Graft Rejection / immunology*
  • Humans
  • Insulin / therapeutic use
  • Kidney Transplantation / immunology*
  • Kidney Transplantation / statistics & numerical data
  • Male
  • Middle Aged
  • Recurrence
  • Time Factors
  • Treatment Outcome

Substances

  • Insulin