title: Long-term impact of pretransplant and posttransplant diabetes mellitus on kidney transplant outcomes.
abstract: BACKGROUND
  The aim of this study was to compare the impact of preexisting diabetes mellitus (pre-DM), posttransplant DM (PTDM), and non-DM on the long-term outcomes of renal transplant recipients (RTRs).
  
  
  METHODS
  This is a retrospective observational cohort study of 427 RTRs who underwent transplantation from 1999 to 2008. Patients were divided into non-DM, pre-DM, and PTDM groups. The primary outcome was the composite of doubling of the serum creatinine (SCr) level, graft failure, or death. Secondary outcomes were biopsy-proven acute rejection (BPAR), biopsy-proven interstitial fibrosis and/or tubular atrophy (IF/TA), and individual components of the primary outcome.
  
  
  RESULTS
  A total of 70 patients (16.4%) had pre-DM, 104 (24.2%) had PTDM, and 253 (59.3%) had non-DM. Kaplan–Meier analysis indicated significant differences in the development of the primary outcome: p = 0.003 (log rank test). Relative to the non-DM group, the pre-DM group had a 6.36-fold increased risk [95% confidence interval (CI) 2.43–16.33; p < 0.001), and the PTDM group had a 2.00-fold increased risk (95% CI 1.08–3.73; p = 0.029) for development of the primary outcome. Patients in the pre-DM group had 6.73-fold (95% CI 2.46–18.42; p < 0.001), 4.56-fold (95% CI 1.77–11.78; p = 0.002), and 13.95-fold (95% CI 2.96–65.75; p < 0.001) increased risks for the development of SCr doubling, biopsy-proven IF/TA, and death-censored graft failure, respectively. Patients in the PTDM group had a 2.09-fold (95% CI 1.10–3.99; p = 0.025), increased risk for the development of SCr doubling.
  
  
  CONCLUSIONS
  The presence of pre-DM or PTDM significantly impaired kidney allograft outcome.
authors: Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
authors: Jen-Pi
authors: JP
authors: Tsai
authors: Jong-Da
authors: JD
authors: Lian
authors: Sheng-Wen
authors: SW
authors: Wu
authors: Tung-Wei
authors: TW
authors: Hung
authors: Hui-Ching
authors: HC
authors: Tsai
authors: Horng-Rong
authors: HR
authors: Chang
mesh_terms: D003920:Diabetes Mellitus / Q000453:epidemiology*; D003928:Diabetic Nephropathies / Q000453:epidemiology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome