Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
Department of Public Health & Maternal and Child Health, Universidad Complutense de Madrid, Madrid, Spain
BMJ Open Diabetes Res Care. 2024 Apr 3;12(2):e003799. doi: 10.1136/bmjdrc-2023-003799.
To assess time trends in incidence, clinical characteristics, complications, and hospital outcomes among patients with type 1 diabetes (T1D), with type 2 diabetes (T2D), and patients without diabetes who underwent kidney transplant (KT); to identify variables associated with in-hospital mortality (IHM); and to determine the impact of the COVID-19 pandemic.
We used a nationwide discharge database to select KT recipients admitted to Spanish hospitals from 2016 to 2020. We stratified patients according to diabetes status. We used multivariable logistic regression to identify the variables associated with IHM.
A total of 14 594 KTs were performed in Spain (T2D, 22.28%; T1D, 3.72%). The number of KTs rose between 2016 and 2019 and and decreased from 2019 to 2020 in all groups. In patients with T2D, the frequency of KT complications increased from 21.08% in 2016 to 34.17% in 2020 (p<0.001). Patients with T2D had significantly more comorbidity than patients with T1D and patients without diabetes (p<0.001). Patients with T1D experienced KT rejection significantly more frequently (8.09%) than patients with T2D (5.57%).COVID-19 was recorded in 26 out of the 2444 KTs performed in 2020, being found in 6 of the 39 patients deceased that year (15.38%) and in 0.83% of the survivors.The variables associated with IHM were comorbidity and complications of KT. The presence of T1D was associated with IHM (OR 2.6; 95% CI 1.36 to 5.16) when patients without diabetes were the reference category. However, T2D was not associated with a higher IHM (OR 0.86; 95% CI 0.61 to 1.2).
The COVID-19 pandemic led to a decrease in the number of transplants. Patients with T1D have more rejection of the transplanted organ than patients with T2D. Fewer women with T2D undergo KT. The presence of T1D is a risk factor for IHM.
评估 1 型糖尿病 (T1D)、2 型糖尿病 (T2D) 和接受肾移植 (KT) 的无糖尿病患者的发病率、临床特征、并发症和医院结局的时间趋势；确定与院内死亡率 (IHM) 相关的变量；并确定 COVID-19 大流行的影响。
我们使用全国性出院数据库选择了 2016 年至 2020 年在西班牙医院接受 KT 的患者。我们根据糖尿病状况对患者进行分层。我们使用多变量逻辑回归来确定与 IHM 相关的变量。
西班牙共进行了 14594 例 KT（T2D，22.28%；T1D，3.72%）。所有组的 KT 数量在 2016 年至 2019 年期间增加，并在 2019 年至 2020 年期间减少。在 T2D 患者中，KT 并发症的频率从 2016 年的 21.08%增加到 2020 年的 34.17%（p<0.001）。与 T1D 患者和无糖尿病患者相比，T2D 患者的合并症明显更多（p<0.001）。T1D 患者的 KT 排斥反应明显比 T2D 患者更频繁（8.09%）。在 2020 年进行的 2444 例 KT 中，记录了 26 例 COVID-19，当年死亡的 39 例患者中有 6 例（15.38%）和 0.83%的幸存者中发现了 COVID-19。与 IHM 相关的变量是 KT 的合并症和并发症。当无糖尿病患者作为参考类别时，T1D 与 IHM 相关（OR 2.6；95%CI 1.36 至 5.16）。然而，T2D 与更高的 IHM 无关（OR 0.86；95%CI 0.61 至 1.2）。
COVID-19 大流行导致移植数量减少。与 T2D 患者相比，T1D 患者的移植器官排斥反应更多。接受 KT 的 T2D 女性较少。T1D 的存在是 IHM 的一个危险因素。
