Maanaoui Mehdi, Debillon Florence, Lenain Rémi, Defrance Frédérique, Vantyghem Marie-Christine, Van Triempont Marine, Provôt François, Chetboun Mikael, Kerr-Conte Julie, Hamroun Aghiles, Frimat Marie, Raverdy Violeta, Pattou François, Hazzan Marc, Glowacki François
Department of Nephrology, CHU Lille, University of Lille, Lille, 59000, France.
U1190 Translational Research for Diabetes, INSERM, Institut Pasteur de Lille, Université Lille, Lille, France.
Sci Rep. 2024 Dec 30;14(1):32081. doi: 10.1038/s41598-024-83817-2.
Type 2 diabetes (T2D) is a common comorbidity in kidney transplant recipients, representing a significant proportion of the candidate pool. Post-kidney transplantation management of T2D remains challenging, leading to inferior long-term outcomes compared to non-diabetic recipients. This study aimed to assess the association between Homeostatic Model Assessment 2 (HOMA2) derived insulin resistance and beta-cell function on kidney graft outcomes in T2D kidney transplant recipients. We conducted a monocentric retrospective study at the University Hospital of Lille, including all consecutive adult T2D patients who underwent kidney transplantation between January 2007 and December 2018. HOMA2 indexes (HOMA2 IR for insulin resistance and HOMA2 B for beta-cell function) were calculated at one-year post-transplantation. Primary endpoint was graft survival and secondary endpoints were death-censored graft survival, patient survival and post-transplant metabolic control. Among 1620 kidney transplant recipients, 138 patients with T2D were included, with a median follow-up of 1837 days [1283-2726]. HOMA2 IR was significantly associated with an increased risk of kidney graft failure or death (HR per unit = 1.11 (1.02-1.21). Beta-cell function was not associated with graft prognosis, but decreased beta-cell function was associated with poorer metabolic control over time. This study highlights the significance of insulin resistance as a potential determinant of long-term outcomes in T2D kidney transplant recipients.
2型糖尿病（T2D）是肾移植受者中常见的合并症，在候选人群中占相当大的比例。肾移植后T2D的管理仍然具有挑战性，与非糖尿病受者相比，长期预后较差。本研究旨在评估2型糖尿病肾移植受者中，基于稳态模型评估2（HOMA2）得出的胰岛素抵抗和β细胞功能与肾移植结局之间的关联。我们在里尔大学医院进行了一项单中心回顾性研究，纳入了2007年1月至2018年12月期间所有连续接受肾移植的成年T2D患者。在移植后一年计算HOMA2指数（HOMA2 IR用于胰岛素抵抗，HOMA2 B用于β细胞功能）。主要终点是移植肾存活，次要终点是死亡 censored移植肾存活、患者存活和移植后代谢控制。在1620名肾移植受者中，纳入了138名T2D患者，中位随访时间为1837天[1283 - 2726]。HOMA2 IR与移植肾失败或死亡风险增加显著相关（每单位HR = 1.11（1.02 - 1.21））。β细胞功能与移植肾预后无关，但随着时间推移，β细胞功能下降与较差的代谢控制相关。本研究强调了胰岛素抵抗作为2型糖尿病肾移植受者长期结局潜在决定因素的重要性。
