This study compared the management and outcomes of kidney transplant recipients with diabetes before (pre-transplant) and after transplantation (post-transplantation diabetes, PTDM). Researchers analysed data from 1,757 patients who received kidney transplants between 2007 and 2018. They found that 11.8% had pre-transplant diabetes, while 13.8% developed PTDM after transplantation. Insulin was the most common treatment for all diabetic patients. The study showed that pre-transplant diabetes was associated with higher mortality, while PTDM had lower mortality in initial analyses. However, in patients followed for at least 5 years, PTDM had no impact on mortality, but pre-transplant diabetes continued to show higher mortality. The study suggests monitoring PTDM as part of long-term care for kidney transplant recipients.

Abstract

Introduction

The aim of this study was to compare the management strategy and clinical outcomes for kidney transplant recipients with pre-transplant versus post-transplantation diabetes (PTDM) in a contemporary cohort.

Methods

This is a single-centre, retrospective. observational study of kidney transplant recipients between 2007 and 2018 with follow-up to 31 December 2020. Data were extracted from hospital electronic patient records, with clinical outcomes linked to national data sets. PTDM was diagnosed by international consensus guidelines. Unadjusted and adjusted survival outcomes were assessed with Kaplan–Meier curves and Cox regression models, respectively, with PTDM handled as a time-varying covariate.

Results

Data were analysed for 1,757 kidney transplant recipients, of whom 11.8% (n = 207) had pre-transplant diabetes, and 13.8% (n = 243) developed PTDM with median time to onset 108 days (IQR 46–549 days). Median follow-up was 1,839 days (IQR 928–2985 days). Disparate management strategies were observed, although insulin was the commonest glucose-lowering therapy for all patients with diabetes. In adjusted models, PTDM was associated with lower mortality (HR 0.663, 95% CI 0.543–0.810) and pre-diabetes with higher mortality (HR 1.675, 95% CI 1.396–2.011). However, if analyses are restricted to those with at least 5-year follow-up, then PTDM has no association with mortality (HR 0.771, 95% CI 0.419–1.096), but pre-transplant diabetes remains associated with higher mortality (HR 2.029, 95% CI 1.367–3.012).

Conclusions

Pre-transplant diabetes remains associated with increased mortality risk after kidney transplantation, but PTDM effects are time dependent. Development of PTDM should be encouraged as a mandated registry return to study the long-term impact on survival outcomes.

Authors: Azm Hussain , Alice Culliford , Nuvreen Phagura , Felicity Evison , Suzy Gallier , Adnan Sharif