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]; > or =1 AR, no PTDM [n=403]; > or =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, > or =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.
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]; > or =1 AR, no PTDM [n=403]; > or =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, > or =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.
Authors: Manfred Hecking; Johannes Werzowa; Michael Haidinger; Walter H Hörl; Julio Pascual; Klemens Budde; Fu L Luan; Akinlolu Ojo; Aiko P J de Vries; Esteban Porrini; Giovanni Pacini; Friedrich K Port; Adnan Sharif; Marcus D Säemann Journal: Nephrol Dial Transplant Date: 2013-01-17 Impact factor: 5.992
Authors: Syed H Ahmed; Tahseen A Chowdhury; Sufyan Hussain; Ateeq Syed; Ali Karamat; Ahmed Helmy; Salman Waqar; Samina Ali; Ammarah Dabhad; Susan T Seal; Anna Hodgkinson; Shazli Azmi; Nazim Ghouri Journal: Diabetes Ther Date: 2020-09-09 Impact factor: 2.945
Authors: Rubab F Malik; Yaqi Jia; Sherry G Mansour; Peter P Reese; Isaac E Hall; Sami Alasfar; Mona D Doshi; Enver Akalin; Jonathan S Bromberg; Meera N Harhay; Sumit Mohan; Thangamani Muthukumar; Bernd Schröppel; Pooja Singh; Francis L Weng; Heather R Thiessen Philbrook; Chirag R Parikh Journal: Kidney360 Date: 2021-06-02
Authors: M Lowe; I R Badell; P Thompson; B Martin; F Leopardi; E Strobert; A A Price; H S Abdulkerim; R Wang; N N Iwakoshi; A B Adams; A D Kirk; C P Larsen; K A Reimann Journal: Am J Transplant Date: 2012-05-08 Impact factor: 8.086
Authors: António W Gomes-Neto; Maryse C J Osté; Camilo G Sotomayor; Else van den Berg; Johanna Marianna Geleijnse; Stefan P Berger; Reinold O B Gans; Stephan J L Bakker; Gerjan J Navis Journal: Clin J Am Soc Nephrol Date: 2020-01-02 Impact factor: 8.237