Posttransplant diabetes mellitus and acute rejection: Impact on kidney transplant outcome

Arthur J. Matas, Kristen J. Gillingham, Abhinav Humar, Hassan N. Ibrahim, William D. Payne, Rainer W G Gruessner, Ty B. Dunn, David E R Sutherland, John S. Najarian, Raja Kandaswamy

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

BACKGROUND. The benefits (e.g., low acute rejection [AR] rate) vs. the long-term risk of each immunosuppressive protocol may determine the protocol's value. METHODS. We studied the long-term impact of new-onset posttransplant diabetes (PTDM) and/or AR in 1,487 adult, primary transplant, nondiabetic recipients. Per Cox regression, donor source, AR, and PTDM were independent risk factors for graft loss (each, p<.0001). Recipients were subdivided by donor source and into these 4 groups: no AR, no PTDM [n=857]; no AR, PTDM [n=134]; ≥1 AR, no PTDM [n=403]; ≥1 AR, PTDM [n=93]. RESULTS. There was a significant difference between groups in 15-yr actuarial graft survival (GS) and death-censored (DC) GS (p<.0001). Importantly, ≥1 AR had more impact on 15-yr GS and DC GS than did PTDM; the worst outcome was for those having both AR and PTDM. In separate analyses, we censored those with >1 AR; and then only compared those developing AR or PTDM in the first year. The results were similar-the AR (no PTDM) group did worse than the PTDM (no AR) group (p<.001). CONCLUSIONS. Determining long-term risks associated with immunosuppressive protocols is important for treating future patients. Our data suggests that 15-year actuarial outcome (GS and DC GS) is worse for those developing AR than for those developing PTDM.

Original languageEnglish (US)
Pages (from-to)338-343
Number of pages6
JournalTransplantation
Volume85
Issue number3
DOIs
StatePublished - Feb 2008
Externally publishedYes

Fingerprint

Immunosuppressive Agents
Diabetes Mellitus
Transplants
Kidney
Tissue Donors
Transplant Recipients

Keywords

  • Acute rejection
  • Diabetes mellitus
  • Kidney transplant

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

Matas, A. J., Gillingham, K. J., Humar, A., Ibrahim, H. N., Payne, W. D., Gruessner, R. W. G., ... Kandaswamy, R. (2008). Posttransplant diabetes mellitus and acute rejection: Impact on kidney transplant outcome. Transplantation, 85(3), 338-343. https://doi.org/10.1097/TP.0b013e318160ee42

Posttransplant diabetes mellitus and acute rejection : Impact on kidney transplant outcome. / Matas, Arthur J.; Gillingham, Kristen J.; Humar, Abhinav; Ibrahim, Hassan N.; Payne, William D.; Gruessner, Rainer W G; Dunn, Ty B.; Sutherland, David E R; Najarian, John S.; Kandaswamy, Raja.

In: Transplantation, Vol. 85, No. 3, 02.2008, p. 338-343.

Research output: Contribution to journalArticle

Matas, AJ, Gillingham, KJ, Humar, A, Ibrahim, HN, Payne, WD, Gruessner, RWG, Dunn, TB, Sutherland, DER, Najarian, JS & Kandaswamy, R 2008, 'Posttransplant diabetes mellitus and acute rejection: Impact on kidney transplant outcome', Transplantation, vol. 85, no. 3, pp. 338-343. https://doi.org/10.1097/TP.0b013e318160ee42
Matas, Arthur J. ; Gillingham, Kristen J. ; Humar, Abhinav ; Ibrahim, Hassan N. ; Payne, William D. ; Gruessner, Rainer W G ; Dunn, Ty B. ; Sutherland, David E R ; Najarian, John S. ; Kandaswamy, Raja. / Posttransplant diabetes mellitus and acute rejection : Impact on kidney transplant outcome. In: Transplantation. 2008 ; Vol. 85, No. 3. pp. 338-343.
@article{383a4e9b18724af7b81ed99a7304ba18,
title = "Posttransplant diabetes mellitus and acute rejection: Impact on kidney transplant outcome",
abstract = "BACKGROUND. The benefits (e.g., low acute rejection [AR] rate) vs. the long-term risk of each immunosuppressive protocol may determine the protocol's value. METHODS. We studied the long-term impact of new-onset posttransplant diabetes (PTDM) and/or AR in 1,487 adult, primary transplant, nondiabetic recipients. Per Cox regression, donor source, AR, and PTDM were independent risk factors for graft loss (each, p<.0001). Recipients were subdivided by donor source and into these 4 groups: no AR, no PTDM [n=857]; no AR, PTDM [n=134]; ≥1 AR, no PTDM [n=403]; ≥1 AR, PTDM [n=93]. RESULTS. There was a significant difference between groups in 15-yr actuarial graft survival (GS) and death-censored (DC) GS (p<.0001). Importantly, ≥1 AR had more impact on 15-yr GS and DC GS than did PTDM; the worst outcome was for those having both AR and PTDM. In separate analyses, we censored those with >1 AR; and then only compared those developing AR or PTDM in the first year. The results were similar-the AR (no PTDM) group did worse than the PTDM (no AR) group (p<.001). CONCLUSIONS. Determining long-term risks associated with immunosuppressive protocols is important for treating future patients. Our data suggests that 15-year actuarial outcome (GS and DC GS) is worse for those developing AR than for those developing PTDM.",
keywords = "Acute rejection, Diabetes mellitus, Kidney transplant",
author = "Matas, {Arthur J.} and Gillingham, {Kristen J.} and Abhinav Humar and Ibrahim, {Hassan N.} and Payne, {William D.} and Gruessner, {Rainer W G} and Dunn, {Ty B.} and Sutherland, {David E R} and Najarian, {John S.} and Raja Kandaswamy",
year = "2008",
month = "2",
doi = "10.1097/TP.0b013e318160ee42",
language = "English (US)",
volume = "85",
pages = "338--343",
journal = "Transplantation",
issn = "0041-1337",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Posttransplant diabetes mellitus and acute rejection

T2 - Impact on kidney transplant outcome

AU - Matas, Arthur J.

AU - Gillingham, Kristen J.

AU - Humar, Abhinav

AU - Ibrahim, Hassan N.

AU - Payne, William D.

AU - Gruessner, Rainer W G

AU - Dunn, Ty B.

AU - Sutherland, David E R

AU - Najarian, John S.

AU - Kandaswamy, Raja

PY - 2008/2

Y1 - 2008/2

N2 - BACKGROUND. The benefits (e.g., low acute rejection [AR] rate) vs. the long-term risk of each immunosuppressive protocol may determine the protocol's value. METHODS. We studied the long-term impact of new-onset posttransplant diabetes (PTDM) and/or AR in 1,487 adult, primary transplant, nondiabetic recipients. Per Cox regression, donor source, AR, and PTDM were independent risk factors for graft loss (each, p<.0001). Recipients were subdivided by donor source and into these 4 groups: no AR, no PTDM [n=857]; no AR, PTDM [n=134]; ≥1 AR, no PTDM [n=403]; ≥1 AR, PTDM [n=93]. RESULTS. There was a significant difference between groups in 15-yr actuarial graft survival (GS) and death-censored (DC) GS (p<.0001). Importantly, ≥1 AR had more impact on 15-yr GS and DC GS than did PTDM; the worst outcome was for those having both AR and PTDM. In separate analyses, we censored those with >1 AR; and then only compared those developing AR or PTDM in the first year. The results were similar-the AR (no PTDM) group did worse than the PTDM (no AR) group (p<.001). CONCLUSIONS. Determining long-term risks associated with immunosuppressive protocols is important for treating future patients. Our data suggests that 15-year actuarial outcome (GS and DC GS) is worse for those developing AR than for those developing PTDM.

AB - BACKGROUND. The benefits (e.g., low acute rejection [AR] rate) vs. the long-term risk of each immunosuppressive protocol may determine the protocol's value. METHODS. We studied the long-term impact of new-onset posttransplant diabetes (PTDM) and/or AR in 1,487 adult, primary transplant, nondiabetic recipients. Per Cox regression, donor source, AR, and PTDM were independent risk factors for graft loss (each, p<.0001). Recipients were subdivided by donor source and into these 4 groups: no AR, no PTDM [n=857]; no AR, PTDM [n=134]; ≥1 AR, no PTDM [n=403]; ≥1 AR, PTDM [n=93]. RESULTS. There was a significant difference between groups in 15-yr actuarial graft survival (GS) and death-censored (DC) GS (p<.0001). Importantly, ≥1 AR had more impact on 15-yr GS and DC GS than did PTDM; the worst outcome was for those having both AR and PTDM. In separate analyses, we censored those with >1 AR; and then only compared those developing AR or PTDM in the first year. The results were similar-the AR (no PTDM) group did worse than the PTDM (no AR) group (p<.001). CONCLUSIONS. Determining long-term risks associated with immunosuppressive protocols is important for treating future patients. Our data suggests that 15-year actuarial outcome (GS and DC GS) is worse for those developing AR than for those developing PTDM.

KW - Acute rejection

KW - Diabetes mellitus

KW - Kidney transplant

UR - http://www.scopus.com/inward/record.url?scp=40049083710&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=40049083710&partnerID=8YFLogxK

U2 - 10.1097/TP.0b013e318160ee42

DO - 10.1097/TP.0b013e318160ee42

M3 - Article

C2 - 18301329

AN - SCOPUS:40049083710

VL - 85

SP - 338

EP - 343

JO - Transplantation

JF - Transplantation

SN - 0041-1337

IS - 3

ER -