Schweer Torben, Gwinner Wilfried, Scheffner Irina, Schwarz Anke, Haller Hermann, Blume Cornelia
Division of Nephrology and Hypertension, Department of Internal Medicine, Hannover Medical School, Hannover, Germany.
Clin Transplant. 2014 Apr;28(4):512-9. doi: 10.1111/ctr.12329. Epub 2014 Mar 21.
Although major risk factors for post-transplant diabetes (PTDM) after kidney transplantation have been identified, a systematic study on the impact of rejection and rejection therapy is missing so far.
Five hundred and twenty-six kidney transplant recipients transplanted in the years 2000-2007 were included. PTDM was defined according to WHO guidelines, and patients' data were compared with special attention to protocol and for cause biopsies and rejection therapies. Survival analyses were made for graft loss and patient death.
16.7% of all patients developed PTDM. Among common risk factors as higher age, body mass index (BMI), and others, the factor "acute cellular rejections" was comparably most relevant with a hazard ratio of 3.7. Consequently, antirejective treatment with steroid pulses and conversion to tacrolimus was the factor with the highest relative risk for the onset of PTDM (RR 3.5). PTDM itself had no impact on graft or patients' survival, but the decreased graft survival in PTDM patients was dominantly influenced by the higher frequency of acute cellular rejections, and patients' survival was reduced due to higher age.
Based upon a higher rate of acute rejections (AR), the necessity of frequent antirejective treatments was more relevant for the induction of PTDM than age or BMI.
尽管肾移植后移植后糖尿病（PTDM）的主要危险因素已被确定，但迄今为止，关于排斥反应和抗排斥治疗影响的系统性研究仍缺失。
纳入2000年至2007年期间接受肾移植的526例受者。根据世界卫生组织指南定义PTDM，并对患者数据进行比较，特别关注方案活检、病因活检和抗排斥治疗。对移植物丢失和患者死亡进行生存分析。
所有患者中有16.7%发生了PTDM。在年龄较大、体重指数（BMI）高等常见危险因素中，“急性细胞排斥反应”这一因素最为相关，风险比为3.7。因此，使用类固醇冲击治疗和转换为他克莫司的抗排斥治疗是PTDM发病相对风险最高的因素（相对风险3.5）。PTDM本身对移植物或患者生存没有影响，但PTDM患者移植物生存率降低主要受急性细胞排斥反应频率较高的影响，而患者生存率因年龄较大而降低。
基于较高的急性排斥反应（AR）发生率，频繁进行抗排斥治疗对于诱发PTDM比年龄或BMI更为重要。
