title: Association of pretransplant glycemic control with posttransplant outcomes in diabetic kidney transplant recipients.
abstract: OBJECTIVE
  Observational studies have yielded inconsistent findings regarding the association of hemoglobin A(1c) (HbA(1c)) with survival in diabetic patients on dialysis. The association between pretransplant glycemic control and short- and long-term posttransplant outcomes in kidney transplant recipients is not clear.
  
  
  METHODS
  Linking the 5-year patient data of a large dialysis organization (DaVita) to the Scientific Registry of Transplant Recipients, we identified 2,872 diabetic dialysis patients who underwent first kidney transplantation. Mortality or graft failure and delayed graft function (DGF) risks were estimated by Cox regression (hazard ratio [HR]) and logistic regression (odds ratio), respectively.
  
  
  RESULTS
  Patients were 53 ± 11 years old and included 36% women and 24% African Americans. In our fully adjusted model, allograft failure-censored, all-cause death HR and 95% CI for time-averaged pretransplant HbA(1c) categories of 7 to <8%, 8 to <9%, 9 to 10%, and ≥10%, compared with 6 to <7% (reference), were 0.89 (0.59-1.36), 2.06 (1.31-3.24), 1.41 (0.73-2.74), and 3.43 (1.56-7.56), respectively; and graft failure-censored cardiovascular death HR was 0.38 (0.13-1.05), 1.78 (0.69-4.55), 1.59 (0.44-5.76), and 4.28 (0.85-21.64), respectively. We did not find any difference in risk of death-censored graft failure or DGF with different pretransplant HbA(1c) levels.
  
  
  CONCLUSIONS
  Poor pretransplant glycemic control appears associated with decreased posttransplant survival in kidney transplant recipients, whereas allograft outcomes may not be affected.
authors: Harold Simmons Center for Chronic Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California, USA.
authors: Miklos Z
authors: MZ
authors: Molnar
authors: Edmund
authors: E
authors: Huang
authors: Junichi
authors: J
authors: Hoshino
authors: Mahesh
authors: M
authors: Krishnan
authors: Allen R
authors: AR
authors: Nissenson
authors: Csaba P
authors: CP
authors: Kovesdy
authors: Kamyar
authors: K
authors: Kalantar-Zadeh
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D051799:Delayed Graft Function / Q000453:epidemiology; D048909:Diabetes Complications / Q000401:mortality* / Q000601:surgery; D005260:Female; D006442:Glycated Hemoglobin; D006084:Graft Rejection / Q000453:epidemiology; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012042:Registries; D006435:Renal Dialysis / Q000401:mortality; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin