Rubab F Malik1, Yaqi Jia1, Sherry G Mansour2,3, Peter P Reese4,5,6, Isaac E Hall7, Sami Alasfar1, Mona D Doshi8, Enver Akalin9, Jonathan S Bromberg10,11, Meera N Harhay12,13,14, Sumit Mohan15,16, Thangamani Muthukumar17,18, Bernd Schröppel19, Pooja Singh20, Francis L Weng21, Heather R Thiessen Philbrook1, Chirag R Parikh1. 1. Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland. 2. Program of Applied Translational Research, Yale University School of Medicine, New Haven, Connecticut. 3. Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut. 4. Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. 5. Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. 6. Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. 7. Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah. 8. Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan. 9. Kidney Transplant Program, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York. 10. Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland. 11. Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, Maryland. 12. Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania. 13. Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania. 14. Tower Health Transplant Institute, Tower Health System, West Reading, Pennsylvania. 15. Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York. 16. Department of Medicine, Columbia University Vagelos College of Physicians & Surgeons, New York, New York. 17. Department of Medicine, Division of Nephrology and Hypertension, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, New York. 18. Department of Transplantation Medicine, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, New York. 19. Section of Nephrology, University Hospital, Ulm, Germany. 20. Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania. 21. Saint Barnabas Medical Center, RWJBarnabas Health, Livingston, New Jersey.
Abstract
Background: De novo post-transplant diabetes mellitus (PTDM) is a common complication after kidney transplant (KT). Most recent studies are single center with various approaches to outcome ascertainment. Methods: In a multicenter longitudinal cohort of 632 nondiabetic adult kidney recipients transplanted in 2010-2013, we ascertained outcomes through detailed chart review at 13 centers. We hypothesized that donor characteristics, such as sex, HCV infection, and kidney donor profile index (KDPI), and recipient characteristics, such as age, race, BMI, and increased HLA mismatches, would affect the development of PTDM among KT recipients. We defined PTDM as hemoglobin A1c ≥6.5%, pharmacological treatment for diabetes, or documentation of diabetes in electronic medical records. We assessed PTDM risk factors and evaluated for an independent time-updated association between PTDM and graft failure using regression. Results: Mean recipient age was 52±14 years, 59% were male, 49% were Black. Cumulative PTDM incidence 5 years post-KT was 29% (186). Independent baseline PTDM risk factors included older recipient age (P<0.001) and higher BMI (P=0.006). PTDM was not associated with all-cause graft failure (adjusted hazard ratio (aHR), 1.10; 95% CI, 0.78 to 1.55), death-censored graft failure (aHR, 0.85; 95% CI, 0.53 to 1.37), or death (aHR, 1.31; 95% CI, 0.84 to 2.05) at median follow-up of 6 (interquartile range, 4.0-6.9) years post-KT. Induction and maintenance immunosuppression were not different between patients who did and did not develop PTDM. Conclusions: PTDM occurred commonly, and higher baseline BMI was associated with PTDM. PTDM was not associated with graft failure or mortality during the 6-year follow-up, perhaps due to the short follow-up time.
Background: De novo post-transplant diabetes mellitus (PTDM) is a common complication after kidney transplant (KT). Most recent studies are single center with various approaches to outcome ascertainment. Methods: In a multicenter longitudinal cohort of 632 nondiabetic adult kidney recipients transplanted in 2010-2013, we ascertained outcomes through detailed chart review at 13 centers. We hypothesized that donor characteristics, such as sex, HCV infection, and kidney donor profile index (KDPI), and recipient characteristics, such as age, race, BMI, and increased HLA mismatches, would affect the development of PTDM among KT recipients. We defined PTDM as hemoglobin A1c ≥6.5%, pharmacological treatment for diabetes, or documentation of diabetes in electronic medical records. We assessed PTDM risk factors and evaluated for an independent time-updated association between PTDM and graft failure using regression. Results: Mean recipient age was 52±14 years, 59% were male, 49% were Black. Cumulative PTDM incidence 5 years post-KT was 29% (186). Independent baseline PTDM risk factors included older recipient age (P<0.001) and higher BMI (P=0.006). PTDM was not associated with all-cause graft failure (adjusted hazard ratio (aHR), 1.10; 95% CI, 0.78 to 1.55), death-censored graft failure (aHR, 0.85; 95% CI, 0.53 to 1.37), or death (aHR, 1.31; 95% CI, 0.84 to 2.05) at median follow-up of 6 (interquartile range, 4.0-6.9) years post-KT. Induction and maintenance immunosuppression were not different between patients who did and did not develop PTDM. Conclusions: PTDM occurred commonly, and higher baseline BMI was associated with PTDM. PTDM was not associated with graft failure or mortality during the 6-year follow-up, perhaps due to the short follow-up time.
Keywords:
United Network for Organ Sharing (UNOS); complication: medical/metabolic; diabetes: new-onset/post-transplant; graft survival; transplantation
Authors: Ivar Anders Eide; Thea Anine Strøm Halden; Anders Hartmann; Anders Åsberg; Dag Olav Dahle; Anna Varberg Reisaeter; Trond Jenssen Journal: Transpl Int Date: 2016-03-09 Impact factor: 3.782
Authors: Motoo Araki; Stuart M Flechner; Hazem R Ismail; Lawrence M Flechner; Lingmei Zhou; Ithaar H Derweesh; David Goldfarb; Charles Modlin; Andrew C Novick; Charles Faiman Journal: Transplantation Date: 2006-02-15 Impact factor: 4.939
Authors: Lidia Ghisdal; Christophe Baron; Yannick Le Meur; Arnaud Lionet; Jean-Michel Halimi; Jean-Philippe Rerolle; François Glowacki; Yvon Lebranchu; Mireille Drouet; Christian Noël; Hakim El Housni; Pascale Cochaux; Karl Martin Wissing; Daniel Abramowicz; Marc Abramowicz Journal: J Am Soc Nephrol Date: 2009-08-27 Impact factor: 10.121
Authors: António W Gomes-Neto; Maryse C J Osté; Camilo G Sotomayor; Else V D Berg; Johanna M Geleijnse; Reinold O B Gans; Stephan J L Bakker; Gerjan J Navis Journal: Diabetes Care Date: 2019-07-11 Impact factor: 19.112
Authors: I E Hall; B Schröppel; M D Doshi; J Ficek; F L Weng; R D Hasz; H Thiessen-Philbrook; P P Reese; C R Parikh Journal: Am J Transplant Date: 2015-03-11 Impact factor: 8.086
Authors: H A Chakkera; R L Hanson; S M Raza; J K DiStefano; M P Millis; R L Heilman; D C Mulligan; K S Reddy; M J Mazur; K Hamawi; A A Moss; K L Mekeel; J R Cerhan Journal: Transplant Proc Date: 2009-12 Impact factor: 1.066
Authors: Panduranga S Rao; Douglas E Schaubel; Mary K Guidinger; Kenneth A Andreoni; Robert A Wolfe; Robert M Merion; Friedrich K Port; Randall S Sung Journal: Transplantation Date: 2009-07-27 Impact factor: 4.939
Authors: Torbjørn F Heldal; Thor Ueland; Trond Jenssen; Anders Hartmann; Anna V Reisaeter; Pål Aukrust; Annika Michelsen; Anders Åsberg Journal: Transpl Int Date: 2018-01-30 Impact factor: 3.782
Authors: Manuela Yepes-Calderón; Camilo G Sotomayor; António W Gomes-Neto; Rijk O B Gans; Stefan P Berger; Gerald Rimbach; Tuba Esatbeyoglu; Ramón Rodrigo; Johanna M Geleijnse; Gerjan J Navis; Stephan J L Bakker Journal: J Clin Med Date: 2019-04-04 Impact factor: 4.241