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不同血糖状态对肾移植结局的影响。

The Effect of Different Glycaemic States on Renal Transplant Outcomes.

作者信息

Sheu Angela, Depczynski Barbara, O'Sullivan Anthony J, Luxton Grant, Mangos George

机构信息

Department of Endocrinology, Prince of Wales Hospital, Randwick, Sydney, NSW, Australia; Prince of Wales Clinical School, UNSW Medicine, Randwick, Sydney, NSW, Australia.

Department of Endocrinology, St George Hospital, Kogarah, Sydney, NSW, Australia; St George & Sutherland Clinical School, UNSW Medicine, Kogarah, Sydney, NSW, Australia.

出版信息

J Diabetes Res. 2016;2016:8735782. doi: 10.1155/2016/8735782. Epub 2016 Dec 7.

DOI:10.1155/2016/8735782
PMID:28053992
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5174175/
Abstract

. Optimal glycaemic targets following transplantation are unknown. Understanding the impact of DM and posttransplant diabetes mellitus (PTDM) may improve patient and graft survival in transplant recipients. . To determine the perioperative and one-year outcomes after renal transplantation and whether these outcomes are affected by preexisting DM, PTDM, or glycaemia during transplant admission. . Adult recipients of renal transplants from a single centre over 5.5 years were retrospectively reviewed. Measured outcomes during transplant admission included glycaemia and complications (infective complications, acute rejection, and return to dialysis) and, at 12 months, glycaemic control and complications (cardiovascular complication, graft failure). . Of 148 patients analysed, 29 (19.6%) had DM and 27 (18.2%) developed PTDM. Following transplantation, glucose levels were higher in patients with DM and PTDM. DM patients had a longer hospital stay, had more infections, and were more likely return to dialysis. PTDM patients had increased rates of acute rejection and return to dialysis. At 1 year after transplant, there were more cardiovascular complications in DM patients compared to those without DM. . Compared to patients without DM, patients with DM or PTDM are more likely to suffer from complications perioperatively and at 12 months. Perioperative glycaemia is associated with graft function and may be a modifiable risk.

摘要

移植后的最佳血糖目标尚不清楚。了解糖尿病(DM)和移植后糖尿病(PTDM)的影响可能会提高移植受者的患者生存率和移植物存活率。

为了确定肾移植后的围手术期和一年期结局,以及这些结局是否受到移植入院时已存在的DM、PTDM或血糖的影响。

对一个单一中心5.5年期间的成年肾移植受者进行了回顾性研究。移植入院期间测量的结局包括血糖和并发症(感染性并发症、急性排斥反应和恢复透析),以及在12个月时的血糖控制和并发症(心血管并发症、移植物功能衰竭)。

在分析的148例患者中,29例(19.6%)患有DM,27例(18.2%)发生了PTDM。移植后,DM和PTDM患者的血糖水平较高。DM患者住院时间更长,感染更多,且更有可能恢复透析。PTDM患者急性排斥反应和恢复透析的发生率增加。移植后1年,与无DM的患者相比,DM患者的心血管并发症更多。

与无DM的患者相比,患有DM或PTDM的患者在围手术期和12个月时更有可能出现并发症。围手术期血糖与移植物功能相关,可能是一个可改变的风险因素。

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本文引用的文献

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Single-centre study of 628 adult, primary kidney transplant recipients showing no unfavourable effect of new-onset diabetes after transplant.一项针对628名成年原发性肾移植受者的单中心研究表明,移植后新发糖尿病没有不良影响。
Diabetologia. 2015 Feb;58(2):334-45. doi: 10.1007/s00125-014-3428-0. Epub 2014 Nov 1.
2
Proceedings from an international consensus meeting on posttransplantation diabetes mellitus: recommendations and future directions.移植后糖尿病国际共识会议纪要:建议与未来方向
Am J Transplant. 2014 Sep;14(9):1992-2000. doi: 10.1111/ajt.12850. Epub 2014 Aug 6.
3
New-onset diabetes after renal transplantation.肾移植术后新发糖尿病
Diabet Med. 2014 Nov;31(11):1284-92. doi: 10.1111/dme.12534.
4
Inflammatory biomarkers, glycemic variability, hypoglycemia, and renal transplant outcomes: results of a randomized controlled trial.炎症生物标志物、血糖变异性、低血糖与肾移植结局:一项随机对照试验的结果。
Transplantation. 2014 Sep 27;98(6):632-9. doi: 10.1097/TP.0000000000000123.
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High impact of rejection therapy on the incidence of post-transplant diabetes mellitus after kidney transplantation.排斥反应治疗对肾移植后移植后糖尿病发病率的高影响。
Clin Transplant. 2014 Apr;28(4):512-9. doi: 10.1111/ctr.12329. Epub 2014 Mar 21.
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Endocr Pract. 2014 Sep;20(9):894-900. doi: 10.4158/EP13463.OR.
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Clin Transplant. 2013 Jul-Aug;27(4):E424-30. doi: 10.1111/ctr.12174. Epub 2013 Jun 30.
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