1 Section of Nephrology, Department of Transplant Medicine, Oslo University Hospital, Rikshospitalet, Norway. 2 Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway. 3 The Norwegian Renal Registry, Oslo University Hospital, Rikshospitalet, Norway. 4 Department of Pharmaceutical Biosciences, School of Pharmacy, University of Oslo, Norway. 5 Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway.
Transplantation. 2017 Jun;101(6):1282-1289. doi: 10.1097/TP.0000000000001259.
Previous reports indicate that posttransplantation diabetes mellitus (PTDM) is associated with overall renal graft loss, but not death-censored graft loss.
In this single-center retrospective cohort study of 2749 adult Norwegian renal transplant recipients, transplanted between 1999 and 2011, we estimated overall and death-censored renal graft loss hazard ratios in patients diagnosed with PTDM, impaired glucose tolerance and diabetes before transplantation, using multivariable Cox proportional hazard regression analysis.
A total of 893 renal grafts were lost during the study period, either due to recipient death (n = 540) or death-censored graft loss (n = 353).When the observational time started at time of transplantation, diabetes before transplantation was associated with both overall and death-censored graft loss. Pretransplantation diabetes was also associated with a steeper decline in renal graft function, a higher risk of acute rejections and more renal grafts lost due to acute rejection.In patients with a functional renal graft 1 year after transplantation, PTDM was associated with overall graft loss (hazard ratio, 1.46; 95% confidence interval, 1.13-1.88; P < 0.001), but not death-censored graft loss (hazard ratio, 1.25; 95% confidence interval, 0.80-1.96; P = 0.33). We found no significant associations between PTDM and change in renal function during the first 5 years or acute rejection risk during the first year after renal transplantation.Impaired glucose tolerance was not associated with either overall or death-censored graft loss.
The present study confirms previous findings of an increased risk of overall but not death-censored renal graft loss in renal transplant recipients with PTDM. Longstanding diabetes might increase the risk of acute rejections.
先前的报告表明，移植后糖尿病（PTDM）与整体肾移植物丢失有关，但与死亡无关的移植物丢失无关。
在这项针对 2749 名成年挪威肾移植受者的单中心回顾性队列研究中，这些受者于 1999 年至 2011 年间接受移植，我们使用多变量 Cox 比例风险回归分析，估计了在移植前被诊断患有 PTDM、葡萄糖耐量受损和糖尿病的患者的整体和死亡无关的移植物丢失风险比。
在研究期间，共有 893 个移植物丢失，要么是由于受者死亡（n = 540），要么是由于死亡无关的移植物丢失（n = 353）。当观察时间从移植时开始时，移植前的糖尿病与整体和死亡无关的移植物丢失均有关。移植前的糖尿病也与肾移植物功能下降更陡峭、急性排斥反应风险更高以及更多的移植物因急性排斥反应丢失有关。在移植后 1 年有功能肾移植物的患者中，PTDM 与整体移植物丢失相关（风险比，1.46；95%置信区间，1.13-1.88；P < 0.001），但与死亡无关的移植物丢失无关（风险比，1.25；95%置信区间，0.80-1.96；P = 0.33）。我们没有发现 PTDM 与前 5 年期间肾功能变化或移植后第 1 年急性排斥反应风险之间存在显著关联。葡萄糖耐量受损与整体或死亡无关的移植物丢失无关。
本研究证实了先前的发现，即 PTDM 肾移植受者整体而非死亡无关的肾移植物丢失风险增加。长期糖尿病可能会增加急性排斥反应的风险。
