Park Seung Shin, Koo Bo Kyung, Park Sanghyun, Han Kyungdo, Moon Min Kyong
Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Diabetes Metab J. 2025 Jan;49(1):117-127. doi: 10.4093/dmj.2024.0078. Epub 2024 Sep 12.
Limited data are available on the adverse effects of new-onset diabetes after transplantation (NODAT) in solid organ transplantation (TPL) other than kidney. This study aimed to identify the risk of complications associated with NODAT in recipients of kidney, liver, or heart TPL.
Using the Korean National Health Insurance Service database, recipients of kidney, liver, or heart TPL between 2009 and 2015 were identified. The incidence of coronary artery disease (CAD), cerebrovascular accident (CVA), and malignancy was compared across groups with NODAT, pretransplant diabetes mellitus (DM), and without DM using Cox regression analysis.
A total of 9,632 kidney, liver, or heart TPL recipients were included. During the median follow-up of 5.9 years, NODAT independently increased the incidence of CAD (hazard ratio [HR], 2.46; 95% confidence interval [CI], 1.39 to 4.30) and overall mortality (HR, 1.48; 95% CI, 1.14 to 1.95) compared to the reference group even after adjustment for confounders; this was more prominent in kidney TPL than in liver TPL. The risk of CVA was significantly increased by pretransplant DM but not by NODAT in both kidney and liver TPL (HR, 2.47; 95% CI, 1.68 to 3.65; and HR, 3.18; 95% CI, 1.07 to 9.48, respectively). NODAT increased the risk of malignancy in the crude model, which lost its statistical significance after confounder adjustment.
NODAT independently increases the risk of CAD and mortality after TPL, which is more evident in kidney recipients. There was no additional increased risk of CVA or malignancy with NODAT in solid organ TPL.
关于实体器官移植（TPL）（肾脏移植除外）后新发糖尿病（NODAT）的不良反应的数据有限。本研究旨在确定肾、肝或心脏TPL受者中与NODAT相关的并发症风险。
利用韩国国民健康保险服务数据库，确定2009年至2015年间肾、肝或心脏TPL的受者。使用Cox回归分析比较了患有NODAT、移植前糖尿病（DM）和无DM的组之间冠状动脉疾病（CAD）、脑血管意外（CVA）和恶性肿瘤的发生率。
共纳入9632例肾、肝或心脏TPL受者。在中位随访5.9年期间，与参照组相比，即使在调整混杂因素后，NODAT仍独立增加CAD的发生率（风险比[HR]，2.46；95%置信区间[CI]，1.39至4.30）和总死亡率（HR，1.48；95%CI，1.14至1.95）；这在肾TPL中比在肝TPL中更明显。在肾和肝TPL中，移植前DM显著增加CVA风险，但NODAT未增加（HR分别为2.47；95%CI，1.68至3.65；和HR，3.18；95%CI，1.07至9.48）。在未调整模型中，NODAT增加恶性肿瘤风险，在调整混杂因素后失去统计学意义。
NODAT独立增加TPL后CAD和死亡风险，这在肾移植受者中更明显。在实体器官TPL中，NODAT未额外增加CVA或恶性肿瘤风险。
