title: The association of early post-transplant glucose levels with long-term mortality.
abstract: OBJECTIVE
  We aimed to assess the long-term effects of post-transplant glycaemia on long-term survival after renal transplantation.
  
  
  METHODS
  Study participants were 1,410 consecutive transplant recipients without known diabetes who underwent an OGTT 10 weeks post-transplant and were observed for a median of 6.7 years (range 0.3-13.8 years). The HRs adjusted for age, sex, traditional risk factors and transplant-related risk factors were estimated.
  
  
  RESULTS
  Each 1 mmol/l increase in fasting plasma glucose (fPG) or 2 h plasma glucose (2hPG) was associated with 11% (95% CI -1%, 24%) and 5% (1%, 9%) increments in all-cause mortality risk and 19% (1%, 39%) and 6% (1%, 12%) increments in cardiovascular (CV) mortality risk, respectively. Including both fPG and 2hPG in the multi-adjusted model the HR for 2hPG remained unchanged, while the HR for fPG was attenuated (1.05 [1.00, 1.11] and 0.97 [0.84, 1.14]). Compared with recipients with normal glucose tolerance, patients with post-transplant diabetes mellitus had higher all-cause and CV mortality (1.54 [1.09, 2.17] and 1.80 [1.10, 2.96]), while patients with impaired glucose tolerance (IGT) had higher all-cause, but not CV mortality (1.39 [1.01, 1.91] and 1.04 [0.62, 1.74]). Conversely, impaired fasting glucose was not associated with increased all-cause or CV mortality (0.79 [0.52, 1.23] and 0.76 [0.39, 1.49]). Post-challenge hyperglycaemia predicted death from any cause and infectious disease in the multivariable analyses (1.49 [1.15, 1.95] and 1.91 [1.09, 3.33]).
  
  
  CONCLUSIONS
  For predicting all-cause and CV mortality, 2hPG is superior to fPG after renal transplantation. Also, early post-transplant diabetes, IGT and post-challenge hyperglycaemia were significant predictors of death. Future studies should determine whether an OGTT helps identify renal transplant recipients at increased risk of premature death.
authors.affiliation: Section for Nephrology, Department for Organ Transplantation, Division for Specialized Medicine and Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway. t.g.valderhaug@medisin.uio.no
authors.forename: T G
authors.initials: TG
authors.lastname: Valderhaug
authors.forename: J
authors.initials: J
authors.lastname: Hjelmesæth
authors.forename: A
authors.initials: A
authors.lastname: Hartmann
authors.forename: J
authors.initials: J
authors.lastname: Røislien
authors.forename: H A
authors.initials: HA
authors.lastname: Bergrem
authors.forename: T
authors.initials: T
authors.lastname: Leivestad
authors.forename: P D
authors.initials: PD
authors.lastname: Line
authors.forename: T
authors.initials: T
authors.lastname: Jenssen
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000401:mortality*; D005215:Fasting / Q000097:blood*; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D006943:Hyperglycemia / Q000097:blood; D016030:Kidney Transplantation / Q000401:mortality*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors
chemical_list: D001786:Blood Glucose