Ahn JiYoon B, Bae Sunjae, Schnitzler Mark, Hess Gregory P, Lentine Krista L, Segev Dorry L, McAdams-DeMarco Mara A
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Transplant Direct. 2021 Dec 13;8(1):e1260. doi: 10.1097/TXD.0000000000001260. eCollection 2022 Jan.
Posttransplant diabetes (PTD), a major complication after kidney transplantation (KT), is often attributable to immunosuppression. The risk of PTD may increase with more potent steroid maintenance and older recipient age.
Using United States Renal Data System data, we studied 12 488 adult first-time KT recipients (2010-2015) with no known pre-KT diabetes. We compared the risk of PTD among recipients who underwent early steroid withdrawal (ESW) versus continued steroid maintenance (CSM) using Cox regression with inverse probability weighting to adjust for confounding. We tested whether the risk of PTD resulting from ESW differed by recipient age (18-29, 30-54, and ≥55 y).
Of 12 488, 28.3% recipients received ESW. The incidence rate for PTD was 13 per 100 person-y and lower among recipients who received ESW (11 per 100 person-y in ESW; 14 per 100 person-y in CSM). Overall, ESW was associated with lower risk of PTD compared with CSM (adjusted hazard ratio [aHR] = 0.79), but the risk differed by recipient age ( = 0.09 for comparison between recipients aged 18-29 and those aged 30-54; = 0.01 for comparison between recipients aged 18-29 and those aged ≥55). ESW was associated with lower risk of PTD among recipients aged ≥55 (aHR = 0.71) and those aged 30-54 (aHR = 0.83), but not among recipients aged 18-29 (aHR = 1.18). Although recipients who received ESW had a higher risk of acute rejection across the age groups (adjusted odds ratio = 1.17), recipients with no PTD had a lower risk of mortality (aHR = 0.66).
The beneficial association of ESW with decreased PTD was more pronounced among recipients aged ≥55, supporting an age-specific assessment of the risk-benefit balance regarding ESW.
移植后糖尿病（PTD）是肾移植（KT）后的一种主要并发症，通常归因于免疫抑制。PTD的风险可能会随着更强效的类固醇维持治疗以及受者年龄的增加而升高。
利用美国肾脏数据系统的数据，我们研究了12488例无已知KT前糖尿病的成年首次KT受者（2010 - 2015年）。我们使用Cox回归和逆概率加权法来调整混杂因素，比较了接受早期停用类固醇（ESW）与继续类固醇维持治疗（CSM）的受者发生PTD的风险。我们检验了ESW导致的PTD风险是否因受者年龄（18 - 29岁、30 - 54岁和≥55岁）而异。
在12488例受者中，28.3%接受了ESW。PTD的发病率为每100人年13例，在接受ESW的受者中较低（ESW组为每100人年11例；CSM组为每100人年14例）。总体而言，与CSM相比，ESW与较低的PTD风险相关（调整后风险比[aHR]=0.79），但风险因受者年龄而异（18 - 29岁受者与30 - 54岁受者比较，P = 0.09；18 - 29岁受者与≥55岁受者比较，P = 0.01）。ESW与≥55岁受者（aHR = 0.71）和30 - 54岁受者（aHR = 0.83）较低的PTD风险相关，但与18 - 29岁受者无关（aHR = 1.18）。尽管接受ESW的受者在各年龄组中发生急性排斥反应的风险较高（调整后优势比 = 1.17），但无PTD的受者死亡风险较低（aHR = 0.66）。
ESW与降低PTD的有益关联在≥55岁的受者中更为明显，这支持了对ESW的风险 - 效益平衡进行年龄特异性评估。
