Impact of acute rejection and new-onset diabetes on long-term transplant graft and patient survival.
OBJECTIVE
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.


METHODS
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.
Cole
Edward H
EH
Division of Nephrology and Multiorgan Transplant Programme, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
Johnston
Olwyn
O
Rose
Caren L
CL
Gill
John S
JS
D000208:Acute Disease; D000328:Adult; D003920:Diabetes Mellitus / Q000209:etiology / Q000401:mortality*; D005260:Female; D006084:Graft Rejection / Q000209:etiology / Q000401:mortality*; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality*; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D018570:Risk Assessment; D013997:Time Factors; D014481:United States / Q000453:epidemiology