title: Early posttransplantation hyperglycemia in kidney transplant recipients is associated with overall long-term graft losses.
abstract: BACKGROUND
  The association of early-onset posttransplantation hyperglycemia with long-term renal allograft survival is unknown.
  
  
  METHODS
  Seventy-one (SD 9) days after transplantation, 1410 first-time kidney transplant recipients without diabetes underwent an oral glucose tolerance test and were observed until primary outcome (graft loss) or December 31, 2008 (median [range], 6.0 years [0.3-13.8 years]). We used multivariable Cox regression analysis adjusted for age, gender, body mass index, creatinine level, donor age, preemptive transplantation, deceased donor, early rejection, and early cytomegalovirus infection to estimate hazard ratios for overall and death-censored allograft survival.
  
  
  RESULTS
  A total of 392 (28%) recipients experienced graft failure, and 235 (60%) were induced by death. Each 1 mmol/L increase in 2-hr plasma glucose (2hPG) was associated with 7% and 3% increased risk of unadjusted and adjusted overall graft failure (hazard ratio [95% confidence interval], 1.07 [1.04-1.10] and 1.03 [1.00-1.07]). Fasting plasma glucose was associated with unadjusted but not adjusted overall graft failure (1.09 [1.01-1.18] and 1.07 [0.98-1.17]). Neither 2hPG nor fasting plasma glucose was associated with death-censored graft loss (P=0.578 and P=0.896). Compared with recipients with normal glucose tolerance, recipients with posttransplantation diabetes mellitus showed a tendency toward increased overall multiadjusted graft failure (1.30 [0.98-1.73]). This was not observed in patients with impaired fasting glucose or impaired glucose tolerance.
  
  
  CONCLUSIONS
  In this study, 2hPG was associated with overall graft failure but not death-censored graft failure. The link between 2hPG and graft failure may be explained by the association with mortality.
authors.affiliation: Department of Transplant Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway. tone.gretland@netcom.no
authors.forename: Tone G
authors.initials: TG
authors.lastname: Valderhaug
authors.forename: Jøran
authors.initials: J
authors.lastname: Hjelmesæth
authors.forename: Trond
authors.initials: T
authors.lastname: Jenssen
authors.forename: Jo
authors.initials: J
authors.lastname: Røislien
authors.forename: Torbjørn
authors.initials: T
authors.lastname: Leivestad
authors.forename: Anders
authors.initials: A
authors.lastname: Hartmann
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D016009:Chi-Square Distribution; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D005260:Female; D005951:Glucose Tolerance Test; D006085:Graft Survival; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009664:Norway; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D001786:Blood Glucose