Impact of metabolic syndrome on graft function and survival after cadaveric renal transplantation.

BACKGROUND

The prevalence and consequences of metabolic syndrome after renal transplantation are not well established. Our aims are to analyze in a historic cohort of consecutive renal transplant recipients without diabetes: (1) the prevalence of metabolic syndrome and its evolution to de novo posttransplantation diabetes mellitus (PTDM), and (2) its impact on graft function and graft and patient survival.

METHODS

We studied 230 transplant recipients with stable graft function at 1 year (baseline) and at least 18 months of follow-up (assessment date). Metabolic syndrome is defined using the Adult Treatment Panel III criteria with a slight modification.

RESULTS

Metabolic syndrome was present in 22.6% of transplant recipients at baseline, increasing to 37.7% at assessment date. Transplant recipients with metabolic syndrome at baseline more frequently developed PTDM during follow-up than those without metabolic syndrome (P < 0.001). In multiple linear regression analysis, metabolic syndrome was an independent risk factor for decreasing inverse serum creatinine (1/Cr) during follow-up (P = 0.038). In Cox proportional analysis, the hazard ratio for a 30% decrease in 1/Cr over time was 2.6 (95% confidence interval, 1.3 to 5.1; P = 0.005). Graft survival was significantly lower in the metabolic-syndrome group (P = 0.008) and remained significant in multivariate Cox analysis (hazard ratios, 3 to 4.5 in different models). Patient survival also was significantly lower in the metabolic-syndrome group (P = 0.02).

CONCLUSION

Metabolic syndrome is a prominent risk factor for PTDM, chronic graft dysfunction, graft loss, and patient death in renal transplant recipients. Because metabolic syndrome is a cluster of modifiable factors, prompt intervention may prevent its consequences.