Revanur V K, Jardine A G, Kingsmore D B, Jaques B C, Hamilton D H, Jindal R M
Department of Medicine, Western Infirmary, University of Glasgow, Glasgow, UK.
Clin Transplant. 2001 Apr;15(2):89-94. doi: 10.1034/j.1399-0012.2001.150202.x.
To investigate the outcomes in patients who have pre-existing diabetes and those who develop post-transplant diabetes mellitus (PTDM).
We retrospectively reviewed the charts of 939 patients who received a first functioning renal transplant in the cyclosporine (CyA) era between 1984 and 1999.
Sixty-six (7%) patients had renal failure due to insulin-dependent diabetes mellitus (IDDM) and 7 (0.8%) patients due to non-insulin-dependent diabetes mellitus (NIDDM). Ten (1.1%) patients had coexistent diabetes and 48 (5.1%) recipients developed PTDM. The mean graft survival for the patients with PTDM was 9.7 yr versus 11.3 yr for the non-diabetic patients, while mean graft survival was 10.1 yr for patients with IDDM and 2.9 yr with NIDDM and 8.3 yr for those with coexistent diabetes (p=ns). However, there was a statistically significant difference in patient survival between patients who developed PTDM and in those who did not develop this complication. The mean survivals of patients with IDDM, NIDDM, coexistent diabetics and PTDM were 8.4, 3.7, 8.6 and 10.3 yr, respectively. The mean survival of the patients without pre-existing diabetes or PTDM was 12.8 yr (p<0.001). The survival of patients older than 55 yr with PTDM was no different to the control group. However, in those younger than 55 yr, PTDM was associated with a higher risk of death (relative risk of 2.54, p<0.001). Fifty percent of patients with IDDM developed acute rejection episodes, whereas rejection rate was 57.1% in NIDDM group, 50.0% in the PTDM group, 20.0% in the coexistent diabetes group and 44.3% in the control group (p=ns).
Patient survival, but not graft survival, was adversely affected by both pre-existing diabetes and by PTDM, particularly in those with an age less than 55 yr.
研究已患糖尿病患者及移植后糖尿病（PTDM）患者的预后情况。
我们回顾性分析了1984年至1999年环孢素（CyA）时代接受首次功能性肾移植的939例患者的病历。
66例（7%）患者因胰岛素依赖型糖尿病（IDDM）导致肾衰竭，7例（0.8%）患者因非胰岛素依赖型糖尿病（NIDDM）导致肾衰竭。10例（1.1%）患者合并糖尿病，48例（5.1%）受者发生PTDM。PTDM患者的平均移植肾存活时间为9.7年，非糖尿病患者为11.3年，IDDM患者平均移植肾存活时间为10.1年，NIDDM患者为2.9年，合并糖尿病患者为8.3年（p=无显著差异）。然而，发生PTDM的患者与未发生该并发症的患者在患者生存率方面存在统计学显著差异。IDDM、NIDDM、合并糖尿病和PTDM患者的平均生存时间分别为8.4年、3.7年、8.6年和10.3年。无糖尿病史或PTDM的患者平均生存时间为12.8年（p<0.001）。年龄大于55岁的PTDM患者生存率与对照组无差异。然而，在年龄小于55岁的患者中，PTDM与更高的死亡风险相关（相对风险为2.54，p<0.001）。50%的IDDM患者发生急性排斥反应，NIDDM组排斥率为57.1%，PTDM组为50.0%，合并糖尿病组为20.0%，对照组为44.3%（p=无显著差异）。
患者生存率而非移植肾存活率受到既往糖尿病和PTDM的不利影响，尤其是在年龄小于55岁的患者中。
