Posttransplant diabetes mellitus and acute rejection: impact on kidney transplant outcome.
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.
Matas
Arthur J
AJ
Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA. matas001@umn.edu
Gillingham
Kristen J
KJ
Humar
Abhinav
A
Ibrahim
Hassan N
HN
Payne
William D
WD
Gruessner
Rainer W G
RW
Dunn
Ty B
TB
Sutherland
David E R
DE
Najarian
John S
JS
Kandaswamy
Raja
R
D000208:Acute Disease; D000328:Adult; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology* / Q000601:surgery*; D005260:Female; D006084:Graft Rejection / Q000276:immunology*; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000276:immunology* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome
D007328:Insulin