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

42 Scopus citations

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 1 2008

Keywords

  • Acute rejection
  • Diabetes mellitus
  • Kidney transplant

ASJC Scopus subject areas

  • Transplantation

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    Matas, A. J., Gillingham, K. J., Humar, A., Ibrahim, H. N., Payne, W. D., Gruessner, R. W. G., Dunn, T. B., Sutherland, D. E. R., Najarian, J. S., & 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