BACKGROUND AND OBJECTIVES: Development of new therapeutic strategies to improve long-term transplant outcomes requires improved understanding of the mechanisms by which these complications limit long-term transplant survival. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The association of acute rejection and new-onset diabetes was determined in the first posttransplantation year with the outcomes of transplant failure from any cause, death-censored graft loss, and death with a functioning graft in 27,707 adult recipients of first kidney-only transplants, with graft survival of at least 1 yr, performed between 1995 and 2002 in the United States. RESULTS: In multivariate analyses, patients who developed acute rejection or new-onset diabetes had a similar risk for transplant failure from any cause, but the mechanisms of transplant failure were different: Acute rejection was associated with death-censored graft loss but only weakly associated with death with a functioning graft. In contrast new-onset diabetes was not associated with death-censored graft loss but was associated with an increased risk for death with a functioning graft. CONCLUSIONS: Acute rejection and new-onset diabetes have a similar impact on long-term transplant survival but lead to transplant failure through different mechanisms. The mechanisms by which new-onset diabetes leads to transplant failure should be prospectively studied. Targeted therapeutic strategies to minimize the impact of various early posttransplantation complications may lead to improved long-term outcomes.
BACKGROUND AND OBJECTIVES: Development of new therapeutic strategies to improve long-term transplant outcomes requires improved understanding of the mechanisms by which these complications limit long-term transplant survival. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The association of acute rejection and new-onset diabetes was determined in the first posttransplantation year with the outcomes of transplant failure from any cause, death-censored graft loss, and death with a functioning graft in 27,707 adult recipients of first kidney-only transplants, with graft survival of at least 1 yr, performed between 1995 and 2002 in the United States. RESULTS: In multivariate analyses, patients who developed acute rejection or new-onset diabetes had a similar risk for transplant failure from any cause, but the mechanisms of transplant failure were different: Acute rejection was associated with death-censored graft loss but only weakly associated with death with a functioning graft. In contrast new-onset diabetes was not associated with death-censored graft loss but was associated with an increased risk for death with a functioning graft. CONCLUSIONS: Acute rejection and new-onset diabetes have a similar impact on long-term transplant survival but lead to transplant failure through different mechanisms. The mechanisms by which new-onset diabetes leads to transplant failure should be prospectively studied. Targeted therapeutic strategies to minimize the impact of various early posttransplantation complications may lead to improved long-term outcomes.
Authors: Fernando G Cosio; Todd E Pesavento; Sunny Kim; Kwame Osei; Mitchell Henry; Ronald M Ferguson Journal: Kidney Int Date: 2002-10 Impact factor: 10.612
Authors: Sean H Chang; Graeme R Russ; Steven J Chadban; Scott B Campbell; Stephen P McDonald Journal: Transplantation Date: 2007-09-15 Impact factor: 4.939
Authors: Franco B Mueller; Hua Yang; Michelle Lubetzky; Akanksha Verma; John R Lee; Darshana M Dadhania; Jenny Z Xiang; Steven P Salvatore; Surya V Seshan; Vijay K Sharma; Olivier Elemento; Manikkam Suthanthiran; Thangamani Muthukumar Journal: JCI Insight Date: 2019-07-11
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: S Fuji; A Rovó; K Ohashi; M Griffith; H Einsele; M Kapp; M Mohty; N S Majhail; B G Engelhardt; A Tichelli; B N Savani Journal: Bone Marrow Transplant Date: 2016-04-04 Impact factor: 5.483