Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia; Australia and New Zealand Dialysis and Transplant Registry, Adelaide, SA, Australia.
Australia and New Zealand Dialysis and Transplant Registry, Adelaide, SA, Australia; Sydney School of Public Health, University of Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, NSW, Australia; Centre for Transplant and Renal Research, Westmead Hospital, NSW, Australia.
Lancet Diabetes Endocrinol. 2017 Jan;5(1):26-33. doi: 10.1016/S2213-8587(16)30317-5.
Overall survival for younger patients with type 2 diabetes without kidney disease has improved substantially over time, but whether a similar pattern of improvement is observed in diabetic kidney transplant recipients remained uncertain. We aimed to compare patient outcomes between diabetic and non-diabetic transplant recipients, and to determine the effect of age and era on patient survival.
This population cohort study included all primary kidney-only transplant recipients included in the Australia and New Zealand Dialysis and Transplant registry between Jan 1, 1994, and Dec 31, 2012. The primary outcomes were all-cause mortality and death with functioning graft. Associations between outcomes and diabetes status were examined using adjusted Cox regression, and interactions between diabetes status and transplant era and recipient age were examined.
Of 10 714 transplant recipients, 985 (9%) had type 2 diabetes. Mortality rates in the first 10 years after transplantation were higher in recipients with diabetes (25·3 per 100 recipients) compared to those without diabetes (11·5 per 100 recipients). Compared with recipients without diabetes, the adjusted hazard ratios (HR) for all-cause mortality and death with a functioning graft in recipients with diabetes were 1·60 (95% CI 1·37-1·86; p<0·0001) and 1·54 (1·28-1·85 p<0·0001), respectively. The association between diabetes status, all-cause mortality, and death with a functioning graft was modified by recipient age (p<0·0001), with the highest risk in recipients with diabetes aged younger than 40 years (adjusted HR 5·16 [95% CI 2·84-9·35], p<0·0001; and 9·83 [4·51-21·43], p<0·0001; for all-cause mortality and death with a functioning graft, respectively). Risk was increased to a lesser extent in recipients with diabetes aged older than 55 years (adjusted HR 1·41 [95% CI 1·17-1·71; p=0·002] and 1·27 [1·02-1·59; p=0·03], for all-cause mortality and death with a functioning graft, respectively). Transplant era did not modify the association between diabetes status and mortality.
Kidney transplant recipients with type 2 diabetes had substantially poorer patient survival, with 5-year mortality rates exceeding those for non-diabetic recipients by over two times. The magnitude of this survival disadvantage was greatest in recipients with diabetes aged less than 40 years. By contrast with the general population, there was no evidence of improvement in mortality over time among people with type 2 diabetes following kidney transplantation.
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随着时间的推移，年轻的 2 型糖尿病且无肾病患者的总体生存率有了显著提高，但糖尿病肾病肾移植受者是否也存在类似的改善模式仍不确定。我们旨在比较糖尿病和非糖尿病移植受者的患者结局，并确定年龄和时代对患者生存率的影响。
本队列研究纳入了 1994 年 1 月 1 日至 2012 年 12 月 31 日期间纳入澳大利亚和新西兰透析和移植登记处的所有原发性肾移植受者。主要结局是全因死亡率和有功能移植物的死亡率。使用调整后的 Cox 回归检验结局与糖尿病状态之间的关联，并检验糖尿病状态与移植时代和受者年龄之间的交互作用。
在 10714 名移植受者中，985 名（9%）患有 2 型糖尿病。与无糖尿病受者（100 名受者中有 11.5 人）相比，移植后 10 年内，糖尿病受者的死亡率更高（25.3 例/100 名受者）。与无糖尿病受者相比，糖尿病受者的全因死亡率和有功能移植物死亡率的调整后的危险比（HR）分别为 1.60（95%CI 1.37-1.86；p<0.0001）和 1.54（1.28-1.85；p<0.0001）。糖尿病状态、全因死亡率和有功能移植物死亡率之间的关联受受者年龄的影响（p<0.0001），在年龄小于 40 岁的糖尿病受者中风险最高（调整后的 HR 5.16 [95%CI 2.84-9.35]，p<0.0001；和 9.83 [4.51-21.43]，p<0.0001；分别为全因死亡率和有功能移植物死亡率）。在年龄大于 55 岁的糖尿病受者中，风险的增加程度较小（调整后的 HR 1.41 [95%CI 1.17-1.71；p=0.002]和 1.27 [1.02-1.59；p=0.03]，分别为全因死亡率和有功能移植物死亡率）。移植时代并未改变糖尿病状态与死亡率之间的关联。
患有 2 型糖尿病的肾移植受者的患者生存率明显较差，5 年死亡率超过非糖尿病受者两倍以上。在年龄小于 40 岁的糖尿病受者中，这种生存劣势的程度最大。与一般人群相比，在接受肾移植后，2 型糖尿病患者的死亡率并没有随着时间的推移而改善。
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