Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
BMJ Open Diabetes Res Care. 2021 May;9(1). doi: 10.1136/bmjdrc-2020-001962.
Little is known about the role diabetes (type 1 (T1D) and type 2 (T2D)) plays in modifying prognosis among kidney transplant recipients. Here, we compare mortality among transplant recipients with T1D, T2D and non-diabetes-related end-stage kidney disease (ESKD).
We included 254 188 first-time single kidney transplant recipients aged ≥18 years from the US Renal Data System (2000-2018). Diabetes status, as primary cause of ESKD, was defined using International Classification of Disease 9th and 10th Clinical Modification codes. Multivariable-adjusted Cox regression models (right-censored) computed risk of death associated with T1D and T2D relative to non-diabetes. Trends in standardized mortality ratios (SMRs) (2000-2017), relative to the general US population, were assessed using Joinpoint regression.
A total of 72 175 (28.4%) deaths occurred over a median survival time of 14.6 years. 5-year survival probabilities were 88%, 85% and 77% for non-diabetes, T1D and T2D, respectively. In adjusted models, mortality was highest for T1D (HR=1.95, (95% CI: 1.88 to 2.03)) and then T2D (1.65 (1.62 to 1.69)), as compared with non-diabetes. SMRs declined for non-diabetes, T1D, and T2D. However, in 2017, SMRs were 2.38 (2.31 to 2.45), 6.55 (6.07 to 7.06), and 3.82 (3.68 to 3.98), for non-diabetes, T1D and T2D, respectively.
In the USA, diabetes type is an important modifier in mortality risk among kidney transplant recipients with highest rates among people with T1D-related ESKD. Development of effective interventions that reduce excess mortality in transplant recipients with diabetes is needed, especially for T1D.
关于糖尿病（1 型（T1D）和 2 型（T2D））在改变肾移植受者预后方面的作用知之甚少。在这里，我们比较了 T1D、T2D 和非糖尿病相关终末期肾病（ESKD）的移植受者的死亡率。
我们纳入了美国肾脏数据系统（2000-2018 年）中 254188 名年龄≥18 岁的首次单肾移植受者。使用国际疾病分类第 9 次和第 10 次临床修正版代码将糖尿病状态作为 ESKD 的主要病因进行定义。使用多变量调整的 Cox 回归模型（右删失）计算 T1D 和 T2D 与非糖尿病相关的死亡风险。使用 Joinpoint 回归评估标准化死亡率比（SMR）（2000-2017 年）相对于一般美国人群的趋势。
中位生存时间为 14.6 年，共发生 72175 例（28.4%）死亡。非糖尿病、T1D 和 T2D 的 5 年生存率分别为 88%、85%和 77%。在调整后的模型中，T1D（HR=1.95，（95%CI：1.88 至 2.03））和 T2D（1.65（1.62 至 1.69））的死亡率最高，而非糖尿病。SMR 下降非糖尿病、T1D 和 T2D。然而，2017 年非糖尿病、T1D 和 T2D 的 SMR 分别为 2.38（2.31 至 2.45）、6.55（6.07 至 7.06）和 3.82（3.68 至 3.98）。
在美国，糖尿病类型是肾移植受者死亡率的重要修饰因子，其中 T1D 相关 ESKD 患者的死亡率最高。需要开发有效的干预措施来降低糖尿病移植受者的过度死亡率，尤其是 T1D。
