肾移植受者移植后糖尿病的预后影响：一项荟萃分析。
Prognostic impact of post-transplant diabetes mellitus in kidney allograft recipients: a meta-analysis.
作者信息
Kanbay Mehmet, Siriopol Dimitrie, Guldan Mustafa, Ozbek Lasin, Topcu Ahmet U, Siriopol Ianis, Tuttle Katherine
机构信息
Division of Nephrology, Department of Medicine, Koc University School of Medicine, Istanbul, Turkey.
Nephrology Department, "Sf. Ioan cel Nou" County Hospital, Suceava, Romania.
出版信息
Nephrol Dial Transplant. 2025 Feb 28;40(3):554-576. doi: 10.1093/ndt/gfae185.
BACKGROUND
Post-transplant diabetes mellitus (PTDM) is a complex condition arising from various factors including immunosuppressive medications, insulin resistance, impaired insulin secretion and inflammatory processes. Its impact on patient and graft survival is a significant concern in kidney transplant recipients. PTDM's impact on kidney transplant recipients, including patient and graft survival and cardiovascular mortality, is a significant concern, given conflicting findings in previous studies. This meta-analysis was imperative not only to incorporate emerging evidence but also to delve into cause-specific mortality considerations. We aimed to comprehensively evaluate the association between PTDM and clinical outcomes, including all-cause and cardiovascular mortality, sepsis-related mortality, malignancy-related mortality and graft loss, in kidney transplant recipients.
METHODS
PubMed, Ovid/Medline, Web of Science, Scopus and Cochrane Library databases were screened and studies evaluating the effect of PTDM on all-cause mortality, cardiovascular mortality, sepsis-related mortality, malignancy-related mortality and overall graft loss in adult kidney transplant recipients were included.
RESULTS
Fifty-three studies, encompassing a total of 138 917 patients, evaluating the association between PTDM and clinical outcomes were included. Our analysis revealed a significant increase in all-cause mortality [risk ratio (RR) 1.70, 95% confidence interval (CI) 1.53 to 1.89, P < .001] and cardiovascular mortality (RR 1.86, 95% CI 1.36 to 2.54, P < .001) among individuals with PTDM. Moreover, PTDM was associated with a higher risk of sepsis-related mortality (RR 1.96, 95% CI 1.51 to 2.54, P < .001) but showed no significant association with malignancy-related mortality (RR 1.20, 95% CI 0.76 to 1.88). Additionally, PTDM was linked to an increased risk of overall graft failure (RR 1.33, 95% CI 1.16 to 1.54, P < .001).
CONCLUSION
These findings underscore the importance of comprehensive management strategies and the need for research targeting PTDM to improve outcomes in kidney transplant recipients.
背景
移植后糖尿病（PTDM）是一种由多种因素引起的复杂病症，这些因素包括免疫抑制药物、胰岛素抵抗、胰岛素分泌受损以及炎症过程。其对患者和移植物存活的影响是肾移植受者的一个重大关切问题。鉴于先前研究结果相互矛盾，PTDM对肾移植受者的影响，包括患者和移植物存活以及心血管死亡率，是一个重大关切问题。这项荟萃分析不仅势在必行，要纳入新出现的证据，而且要深入探讨特定病因的死亡率考量。我们旨在全面评估肾移植受者中PTDM与临床结局之间的关联，包括全因死亡率、心血管死亡率、脓毒症相关死亡率、恶性肿瘤相关死亡率和移植物丢失。
方法
对PubMed、Ovid/Medline、科学引文索引、Scopus和Cochrane图书馆数据库进行筛选，纳入评估PTDM对成年肾移植受者全因死亡率、心血管死亡率、脓毒症相关死亡率、恶性肿瘤相关死亡率和总体移植物丢失影响的研究。
结果
纳入了53项研究，共涉及138917名患者，评估PTDM与临床结局之间的关联。我们的分析显示，PTDM患者的全因死亡率[风险比（RR）1.70，95%置信区间（CI）1.53至1.89，P <.001]和心血管死亡率（RR 1.86，95%CI 1.36至2.54，P <.001）显著增加。此外，PTDM与脓毒症相关死亡率较高风险相关（RR 1.96，95%CI 1.51至2.54，P <.001），但与恶性肿瘤相关死亡率无显著关联（RR 1.20，95%CI 0.76至1.88）。此外，PTDM与总体移植物失败风险增加相关（RR 1.33，95%CI 1.16至1.54，P <.001）。
结论
这些发现强调了综合管理策略的重要性以及针对PTDM进行研究以改善肾移植受者结局的必要性。
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