Single-centre study of 628 adult, primary kidney transplant recipients showing no unfavourable effect of new-onset diabetes after transplant

Jeffrey Gaynor, Gaetano Ciancio, Giselle Guerra, Junichiro Sageshima, Lois Hanson, David Roth, Michael Goldstein, Linda J Chen, Warren Kupin, Adela D Mattiazzi, Lissett Tueros, Sandra Flores, Luis J. Barba, Adrian Lopez, Jose Rivas, Phillip Ruiz, Rodrigo Vianna, George W Burke

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Abstract

Aims/hypothesis: To better understand the implications of new-onset diabetes after transplant (NODAT), we used our prospectively followed cohort of 628 adult primary kidney transplant recipients to determine the prognostic impact of pretransplant diabetes and NODAT.

Methods: The study cohort consisted of all participants in four randomised immunosuppression trials performed at our centre since May 2000. For each cause-specific hazard analysed, Cox stepwise regression was used to determine a multivariable model of significant baseline predictors; the multivariable influence of having pretransplant diabetes and NODAT (t) (the latter defined as a zero-one, time-dependent covariate) was subsequently tested. Similar analyses of estimated glomerular filtration rate (eGFR) at 36 and 60 months post transplant were performed using stepwise linear regression. Finally, a repeated measures analysis of mean HbA1c as a function of diabetes category (pretransplant diabetes vs NODAT) and randomised trial (first to fourth) was performed.

Results: Median follow-up was 56 months post transplant. Patients with pretransplant diabetes comprised 23.4% (147/628), and 22.5% (108/481) of the remaining patients developed NODAT. Pretransplant diabetes had no prognostic influence on first biopsy-proven acute rejection and death-censored graft failure hazard rates, nor on eGFR, but was associated with significantly higher rates of death with a functioning graft (DWFG) (p = 0.003), DWFG due to a cardiovascular event (p = 0.005) and infection that required hospitalisation (p = 0.03). NODAT (t) had no unfavourable impact on any of these hazard rates nor on eGFR, with actuarial freedom from DWFG remaining at over 90% among patients in pre- and post-NODAT states at 72 months post transplant/NODAT. Mean HbA1c for patients in the first to fourth randomised trials, averaged across diabetes category, decreased by trial (7.28%, 6.92%, 6.87% and 6.64% [56.1, 52.1, 51.6 and 49.1 mmol/mol], respectively; p = 0.02).

Conclusions/interpretation: Less-than-expected post-NODAT risk for graft loss and death may exist in the current climate of tighter glucose monitoring post transplant.

Original languageEnglish
JournalDiabetologia
DOIs
StateAccepted/In press - Nov 1 2014

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Transplants
Kidney
Glomerular Filtration Rate
Transplant Recipients
Climate
Immunosuppression
Linear Models
Hospitalization
Cohort Studies
Biopsy
Glucose

Keywords

  • Kidney transplantation
  • New-onset diabetes after transplant
  • Pretransplant diabetes mellitus
  • Prognostic impact

Cite this

@article{639474021b5d45729704047a9cbf9172,
title = "Single-centre study of 628 adult, primary kidney transplant recipients showing no unfavourable effect of new-onset diabetes after transplant",
abstract = "Aims/hypothesis: To better understand the implications of new-onset diabetes after transplant (NODAT), we used our prospectively followed cohort of 628 adult primary kidney transplant recipients to determine the prognostic impact of pretransplant diabetes and NODAT.Methods: The study cohort consisted of all participants in four randomised immunosuppression trials performed at our centre since May 2000. For each cause-specific hazard analysed, Cox stepwise regression was used to determine a multivariable model of significant baseline predictors; the multivariable influence of having pretransplant diabetes and NODAT (t) (the latter defined as a zero-one, time-dependent covariate) was subsequently tested. Similar analyses of estimated glomerular filtration rate (eGFR) at 36 and 60 months post transplant were performed using stepwise linear regression. Finally, a repeated measures analysis of mean HbA1c as a function of diabetes category (pretransplant diabetes vs NODAT) and randomised trial (first to fourth) was performed.Results: Median follow-up was 56 months post transplant. Patients with pretransplant diabetes comprised 23.4{\%} (147/628), and 22.5{\%} (108/481) of the remaining patients developed NODAT. Pretransplant diabetes had no prognostic influence on first biopsy-proven acute rejection and death-censored graft failure hazard rates, nor on eGFR, but was associated with significantly higher rates of death with a functioning graft (DWFG) (p = 0.003), DWFG due to a cardiovascular event (p = 0.005) and infection that required hospitalisation (p = 0.03). NODAT (t) had no unfavourable impact on any of these hazard rates nor on eGFR, with actuarial freedom from DWFG remaining at over 90{\%} among patients in pre- and post-NODAT states at 72 months post transplant/NODAT. Mean HbA1c for patients in the first to fourth randomised trials, averaged across diabetes category, decreased by trial (7.28{\%}, 6.92{\%}, 6.87{\%} and 6.64{\%} [56.1, 52.1, 51.6 and 49.1 mmol/mol], respectively; p = 0.02).Conclusions/interpretation: Less-than-expected post-NODAT risk for graft loss and death may exist in the current climate of tighter glucose monitoring post transplant.",
keywords = "Kidney transplantation, New-onset diabetes after transplant, Pretransplant diabetes mellitus, Prognostic impact",
author = "Jeffrey Gaynor and Gaetano Ciancio and Giselle Guerra and Junichiro Sageshima and Lois Hanson and David Roth and Michael Goldstein and Chen, {Linda J} and Warren Kupin and Mattiazzi, {Adela D} and Lissett Tueros and Sandra Flores and Barba, {Luis J.} and Adrian Lopez and Jose Rivas and Phillip Ruiz and Rodrigo Vianna and Burke, {George W}",
year = "2014",
month = "11",
day = "1",
doi = "10.1007/s00125-014-3428-0",
language = "English",
journal = "Diabetologia",
issn = "0012-186X",
publisher = "Springer Verlag",

}

TY - JOUR

T1 - Single-centre study of 628 adult, primary kidney transplant recipients showing no unfavourable effect of new-onset diabetes after transplant

AU - Gaynor, Jeffrey

AU - Ciancio, Gaetano

AU - Guerra, Giselle

AU - Sageshima, Junichiro

AU - Hanson, Lois

AU - Roth, David

AU - Goldstein, Michael

AU - Chen, Linda J

AU - Kupin, Warren

AU - Mattiazzi, Adela D

AU - Tueros, Lissett

AU - Flores, Sandra

AU - Barba, Luis J.

AU - Lopez, Adrian

AU - Rivas, Jose

AU - Ruiz, Phillip

AU - Vianna, Rodrigo

AU - Burke, George W

PY - 2014/11/1

Y1 - 2014/11/1

N2 - Aims/hypothesis: To better understand the implications of new-onset diabetes after transplant (NODAT), we used our prospectively followed cohort of 628 adult primary kidney transplant recipients to determine the prognostic impact of pretransplant diabetes and NODAT.Methods: The study cohort consisted of all participants in four randomised immunosuppression trials performed at our centre since May 2000. For each cause-specific hazard analysed, Cox stepwise regression was used to determine a multivariable model of significant baseline predictors; the multivariable influence of having pretransplant diabetes and NODAT (t) (the latter defined as a zero-one, time-dependent covariate) was subsequently tested. Similar analyses of estimated glomerular filtration rate (eGFR) at 36 and 60 months post transplant were performed using stepwise linear regression. Finally, a repeated measures analysis of mean HbA1c as a function of diabetes category (pretransplant diabetes vs NODAT) and randomised trial (first to fourth) was performed.Results: Median follow-up was 56 months post transplant. Patients with pretransplant diabetes comprised 23.4% (147/628), and 22.5% (108/481) of the remaining patients developed NODAT. Pretransplant diabetes had no prognostic influence on first biopsy-proven acute rejection and death-censored graft failure hazard rates, nor on eGFR, but was associated with significantly higher rates of death with a functioning graft (DWFG) (p = 0.003), DWFG due to a cardiovascular event (p = 0.005) and infection that required hospitalisation (p = 0.03). NODAT (t) had no unfavourable impact on any of these hazard rates nor on eGFR, with actuarial freedom from DWFG remaining at over 90% among patients in pre- and post-NODAT states at 72 months post transplant/NODAT. Mean HbA1c for patients in the first to fourth randomised trials, averaged across diabetes category, decreased by trial (7.28%, 6.92%, 6.87% and 6.64% [56.1, 52.1, 51.6 and 49.1 mmol/mol], respectively; p = 0.02).Conclusions/interpretation: Less-than-expected post-NODAT risk for graft loss and death may exist in the current climate of tighter glucose monitoring post transplant.

AB - Aims/hypothesis: To better understand the implications of new-onset diabetes after transplant (NODAT), we used our prospectively followed cohort of 628 adult primary kidney transplant recipients to determine the prognostic impact of pretransplant diabetes and NODAT.Methods: The study cohort consisted of all participants in four randomised immunosuppression trials performed at our centre since May 2000. For each cause-specific hazard analysed, Cox stepwise regression was used to determine a multivariable model of significant baseline predictors; the multivariable influence of having pretransplant diabetes and NODAT (t) (the latter defined as a zero-one, time-dependent covariate) was subsequently tested. Similar analyses of estimated glomerular filtration rate (eGFR) at 36 and 60 months post transplant were performed using stepwise linear regression. Finally, a repeated measures analysis of mean HbA1c as a function of diabetes category (pretransplant diabetes vs NODAT) and randomised trial (first to fourth) was performed.Results: Median follow-up was 56 months post transplant. Patients with pretransplant diabetes comprised 23.4% (147/628), and 22.5% (108/481) of the remaining patients developed NODAT. Pretransplant diabetes had no prognostic influence on first biopsy-proven acute rejection and death-censored graft failure hazard rates, nor on eGFR, but was associated with significantly higher rates of death with a functioning graft (DWFG) (p = 0.003), DWFG due to a cardiovascular event (p = 0.005) and infection that required hospitalisation (p = 0.03). NODAT (t) had no unfavourable impact on any of these hazard rates nor on eGFR, with actuarial freedom from DWFG remaining at over 90% among patients in pre- and post-NODAT states at 72 months post transplant/NODAT. Mean HbA1c for patients in the first to fourth randomised trials, averaged across diabetes category, decreased by trial (7.28%, 6.92%, 6.87% and 6.64% [56.1, 52.1, 51.6 and 49.1 mmol/mol], respectively; p = 0.02).Conclusions/interpretation: Less-than-expected post-NODAT risk for graft loss and death may exist in the current climate of tighter glucose monitoring post transplant.

KW - Kidney transplantation

KW - New-onset diabetes after transplant

KW - Pretransplant diabetes mellitus

KW - Prognostic impact

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U2 - 10.1007/s00125-014-3428-0

DO - 10.1007/s00125-014-3428-0

M3 - Article

C2 - 25361829

AN - SCOPUS:84922004007

JO - Diabetologia

JF - Diabetologia

SN - 0012-186X

ER -