Section for Nephrology, Department for Organ Transplantation, Division for Specialized Medicine and Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
Diabetologia. 2011 Jun;54(6):1341-9. doi: 10.1007/s00125-011-2105-9. Epub 2011 Mar 16.
AIMS/OBJECTIVE: We aimed to assess the long-term effects of post-transplant glycaemia on long-term survival after renal transplantation.
Study participants were 1,410 consecutive transplant recipients without known diabetes who underwent an OGTT 10 weeks post-transplant and were observed for a median of 6.7 years (range 0.3-13.8 years). The HRs adjusted for age, sex, traditional risk factors and transplant-related risk factors were estimated.
Each 1 mmol/l increase in fasting plasma glucose (fPG) or 2 h plasma glucose (2hPG) was associated with 11% (95% CI -1%, 24%) and 5% (1%, 9%) increments in all-cause mortality risk and 19% (1%, 39%) and 6% (1%, 12%) increments in cardiovascular (CV) mortality risk, respectively. Including both fPG and 2hPG in the multi-adjusted model the HR for 2hPG remained unchanged, while the HR for fPG was attenuated (1.05 [1.00, 1.11] and 0.97 [0.84, 1.14]). Compared with recipients with normal glucose tolerance, patients with post-transplant diabetes mellitus had higher all-cause and CV mortality (1.54 [1.09, 2.17] and 1.80 [1.10, 2.96]), while patients with impaired glucose tolerance (IGT) had higher all-cause, but not CV mortality (1.39 [1.01, 1.91] and 1.04 [0.62, 1.74]). Conversely, impaired fasting glucose was not associated with increased all-cause or CV mortality (0.79 [0.52, 1.23] and 0.76 [0.39, 1.49]). Post-challenge hyperglycaemia predicted death from any cause and infectious disease in the multivariable analyses (1.49 [1.15, 1.95] and 1.91 [1.09, 3.33]).
CONCLUSIONS/INTERPRETATION: For predicting all-cause and CV mortality, 2hPG is superior to fPG after renal transplantation. Also, early post-transplant diabetes, IGT and post-challenge hyperglycaemia were significant predictors of death. Future studies should determine whether an OGTT helps identify renal transplant recipients at increased risk of premature death.
评估移植后血糖对肾移植后长期生存的长期影响。
本研究纳入 1410 名移植后无已知糖尿病的连续移植受者，他们在移植后 10 周进行 OGTT，并中位随访 6.7 年（范围 0.3-13.8 年）。根据年龄、性别、传统危险因素和移植相关危险因素对 HR 进行调整。
空腹血糖（fPG）或 2 小时血糖（2hPG）每增加 1mmol/L，全因死亡率风险分别增加 11%（95%CI：-1%，24%）和 5%（1%，9%），心血管死亡率风险分别增加 19%（1%，39%）和 6%（1%，12%）。在多因素调整模型中同时纳入 fPG 和 2hPG 时，2hPG 的 HR 保持不变，而 fPG 的 HR 减弱（1.05[1.00，1.11]和 0.97[0.84，1.14]）。与糖耐量正常的受者相比，移植后糖尿病患者的全因和心血管死亡率更高（1.54[1.09，2.17]和 1.80[1.10，2.96]），而糖耐量受损（IGT）患者的全因死亡率更高，但心血管死亡率没有升高（1.39[1.01，1.91]和 1.04[0.62，1.74]）。相反，空腹血糖受损与全因或心血管死亡率增加无关（0.79[0.52，1.23]和 0.76[0.39，1.49]）。在多变量分析中，餐后高血糖预测全因死亡和感染性疾病（1.49[1.15，1.95]和 1.91[1.09，3.33]）。
对于预测全因和心血管死亡率，移植后 2hPG 优于 fPG。此外，移植后早期糖尿病、IGT 和餐后高血糖是死亡的显著预测因子。未来的研究应确定 OGTT 是否有助于确定发生过早死亡风险增加的肾移植受者。
