Department of Transplant Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
Transplantation. 2012 Oct 15;94(7):714-20. doi: 10.1097/TP.0b013e31825f4434.
The association of early-onset posttransplantation hyperglycemia with long-term renal allograft survival is unknown.
Seventy-one (SD 9) days after transplantation, 1410 first-time kidney transplant recipients without diabetes underwent an oral glucose tolerance test and were observed until primary outcome (graft loss) or December 31, 2008 (median [range], 6.0 years [0.3-13.8 years]). We used multivariable Cox regression analysis adjusted for age, gender, body mass index, creatinine level, donor age, preemptive transplantation, deceased donor, early rejection, and early cytomegalovirus infection to estimate hazard ratios for overall and death-censored allograft survival.
A total of 392 (28%) recipients experienced graft failure, and 235 (60%) were induced by death. Each 1 mmol/L increase in 2-hr plasma glucose (2hPG) was associated with 7% and 3% increased risk of unadjusted and adjusted overall graft failure (hazard ratio [95% confidence interval], 1.07 [1.04-1.10] and 1.03 [1.00-1.07]). Fasting plasma glucose was associated with unadjusted but not adjusted overall graft failure (1.09 [1.01-1.18] and 1.07 [0.98-1.17]). Neither 2hPG nor fasting plasma glucose was associated with death-censored graft loss (P=0.578 and P=0.896). Compared with recipients with normal glucose tolerance, recipients with posttransplantation diabetes mellitus showed a tendency toward increased overall multiadjusted graft failure (1.30 [0.98-1.73]). This was not observed in patients with impaired fasting glucose or impaired glucose tolerance.
In this study, 2hPG was associated with overall graft failure but not death-censored graft failure. The link between 2hPG and graft failure may be explained by the association with mortality.
早期移植后高血糖与长期肾移植存活率的关系尚不清楚。
在移植后 71 天（SD 9 天），1410 名首次接受肾移植且无糖尿病的患者接受了口服葡萄糖耐量试验，并观察至主要结局（移植物丢失）或 2008 年 12 月 31 日（中位数[范围]：6.0 年[0.3-13.8 年]）。我们使用多变量 Cox 回归分析，根据年龄、性别、体重指数、肌酐水平、供体年龄、抢先移植、已故供体、早期排斥和早期巨细胞病毒感染进行调整，以估计总生存率和死亡校正移植物存活率的风险比。
共有 392 名（28%）受者发生移植物衰竭，其中 235 名（60%）由死亡引起。2 小时血浆葡萄糖（2hPG）每升高 1mmol/L，未调整和调整后的总移植物衰竭风险分别增加 7%和 3%（风险比[95%置信区间]：1.07[1.04-1.10]和 1.03[1.00-1.07]）。空腹血糖与未调整的总移植物衰竭相关，但与调整后的总移植物衰竭无关（1.09[1.01-1.18]和 1.07[0.98-1.17]）。2hPG 和空腹血糖均与死亡校正的移植物丢失无关（P=0.578 和 P=0.896）。与糖耐量正常的受者相比，移植后糖尿病受者的整体多调整移植物衰竭呈增加趋势（1.30[0.98-1.73]）。但在空腹血糖受损或糖耐量受损的患者中并未观察到这种情况。
在这项研究中，2hPG 与整体移植物衰竭相关，但与死亡校正的移植物衰竭无关。2hPG 与移植物衰竭之间的联系可能可以通过与死亡率的关系来解释。
