Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
World J Surg. 2011 Dec;35(12):2818-25. doi: 10.1007/s00268-011-1287-0.
The aim of this study was to compare the impact of preexisting diabetes mellitus (pre-DM), posttransplant DM (PTDM), and non-DM on the long-term outcomes of renal transplant recipients (RTRs).
This is a retrospective observational cohort study of 427 RTRs who underwent transplantation from 1999 to 2008. Patients were divided into non-DM, pre-DM, and PTDM groups. The primary outcome was the composite of doubling of the serum creatinine (SCr) level, graft failure, or death. Secondary outcomes were biopsy-proven acute rejection (BPAR), biopsy-proven interstitial fibrosis and/or tubular atrophy (IF/TA), and individual components of the primary outcome.
A total of 70 patients (16.4%) had pre-DM, 104 (24.2%) had PTDM, and 253 (59.3%) had non-DM. Kaplan–Meier analysis indicated significant differences in the development of the primary outcome: p = 0.003 (log rank test). Relative to the non-DM group, the pre-DM group had a 6.36-fold increased risk [95% confidence interval (CI) 2.43–16.33; p < 0.001), and the PTDM group had a 2.00-fold increased risk (95% CI 1.08–3.73; p = 0.029) for development of the primary outcome. Patients in the pre-DM group had 6.73-fold (95% CI 2.46–18.42; p < 0.001), 4.56-fold (95% CI 1.77–11.78; p = 0.002), and 13.95-fold (95% CI 2.96–65.75; p < 0.001) increased risks for the development of SCr doubling, biopsy-proven IF/TA, and death-censored graft failure, respectively. Patients in the PTDM group had a 2.09-fold (95% CI 1.10–3.99; p = 0.025), increased risk for the development of SCr doubling.
The presence of pre-DM or PTDM significantly impaired kidney allograft outcome.
本研究旨在比较移植前糖尿病（pre-DM）、移植后糖尿病（PTDM）和非糖尿病对肾移植受者（RTR）长期结局的影响。
这是一项回顾性观察队列研究，纳入了 1999 年至 2008 年间接受移植的 427 名 RTR。患者分为非糖尿病组、pre-DM 组和 PTDM 组。主要结局是血清肌酐（SCr）水平翻倍、移植物失功或死亡的复合结局。次要结局是经活检证实的急性排斥反应（BPAR）、经活检证实的间质纤维化和/或肾小管萎缩（IF/TA）以及主要结局的各个组成部分。
共有 70 名患者（16.4%）患有 pre-DM，104 名患者（24.2%）患有 PTDM，253 名患者（59.3%）患有非糖尿病。Kaplan-Meier 分析表明，主要结局的发展存在显著差异：p = 0.003（对数秩检验）。与非糖尿病组相比，pre-DM 组发生主要结局的风险增加了 6.36 倍[95%置信区间（CI）2.43-16.33；p < 0.001]，PTDM 组的风险增加了 2 倍（95%CI 1.08-3.73；p = 0.029）。pre-DM 组患者发生 SCr 翻倍、经活检证实的 IF/TA 和死亡相关移植物失功的风险分别增加了 6.73 倍（95%CI 2.46-18.42；p < 0.001）、4.56 倍（95%CI 1.77-11.78；p = 0.002）和 13.95 倍（95%CI 2.96-65.75；p < 0.001）。PTDM 组患者发生 SCr 翻倍的风险增加了 2.09 倍（95%CI 1.10-3.99；p = 0.025）。
pre-DM 或 PTDM 的存在显著影响肾移植受者的移植物结局。
