Endocrinol Metab.  2023 Feb;38(1):139-145. 10.3803/EnM.2022.1594.

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

Affiliations
  • 1Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
  • 2Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
  • 3Office of Biostatistics, Medical Research Collaboration Center, Ajou Research Institute for Innovation, Ajou University Medical Center, Suwon, Korea

Abstract

Background
Post-transplant diabetes mellitus (PTDM) is a risk factor for poor outcomes after kidney transplantation (KT). However, the outcomes of KT have improved recently. Therefore, we investigated whether PTDM is still a risk factor for mortality, major atherosclerotic cardiovascular events (MACEs), and graft failure in KT recipients.
Methods
We studied a retrospective cohort of KT recipients (between 1994 and 2017) at a single tertiary center, and compared the rates of death, MACEs, overall graft failure, and death-censored graft failure after KT between patients with and without PTDM using Kaplan-Meier analysis and a Cox proportional hazard model.
Results
Of 571 KT recipients, 153 (26.8%) were diagnosed with PTDM. The mean follow-up duration was 9.6 years. In the Kaplan- Meier analysis, the PTDM group did not have a significantly increased risk of death or four-point MACE compared with the non-diabetes mellitus group (log-rank test, P=0.957 and P=0.079, respectively). Multivariate Cox proportional hazard models showed that PTDM did not have a negative impact on death or four-point MACE (P=0.137 and P=0.181, respectively). In addition, PTDM was not significantly associated with overall or death-censored graft failure. However, patients with a long duration of PTDM had a higher incidence of four-point MACE.
Conclusion
Patient survival and MACEs were comparable between groups with and without PTDM. However, PTDM patients with long duration diabetes were at higher risk of cardiovascular disease.

Keyword

Kidney transplantation; Diabetes mellitus; Cardiovascular diseases; Mortality; Graft survival

Figure

  • Fig. 1. Kaplan-Meier curves for all-cause mortality and four-point major adverse cardiovascular events according to post-transplant diabetes mellitus (PTDM) status (log-rank test, P=0.957 and P=0.079, respectively). (A) All-cause mortality. (B) Four-point major adverse cardiovascular events.


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