title: Effects of acute rejection vs new-onset diabetes after transplant on transplant outcomes in pediatric kidney recipients: analysis of the Organ Procurement and Transplant Network/United Network for Organ Sharing (OPTN/UNOS) database.
abstract: Improving long-term transplant and patient survival is still an ongoing challenge in kidney transplant medicine. Our objective was to identify the subsequent risks of new-onset diabetes after transplant (NODAT) and acute rejection (AR) in the first year post-transplant in predicting mortality and transplant failure. A total of 4687 patients without preexisting diabetes (age 2-20 years, 2004-2010) surviving with a functioning transplant for longer than 1 year with at least one follow-up report were identified from the OPTN/UNOS database as of September 2014. Study population was stratified into four mutually exclusive groups: Group 1, patients with a history of AR; Group 2, NODAT+; Group 3, NODAT+ AR+; and Group 4, the reference group (neither). Multivariate regression was used to analyze the relative risks for the outcomes of transplant failure and mortality. The median follow-up time was 1827 days after 1 year post-transplant. AR was associated with an increased risk of adjusted graft and death-censored graft failure (HR 2.87, CI 2.48-3.33, P < .001 and HR 2.11, CI 1.81-2.47, P < .001), respectively. NODAT and AR were identified in 3.5% and 14.5% of all study patients, respectively. AR in the first year post-transplant was a major risk factor for overall and death-censored graft failure, but not mortality. However, NODAT was not a risk factor on graft survival or mortality.
authors: Kidney Transplant Program, University of California, CA, USA.
authors: Alireza
authors: A
authors: Mehrnia
authors: Kidney Transplant Program, University of California, CA, USA.
authors: Thuy X
authors: TX
authors: Le
authors: Kidney Transplant Program, University of California, CA, USA.
authors: Tamer R
authors: TR
authors: Tamer
authors: Kidney Transplant Program, University of California, CA, USA. bunnapradist@mednet.ucla.edu.
authors: Suphamai
authors: S
authors: Bunnapradist
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000209:etiology*; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation; D015999:Multivariate Analysis; D012307:Risk Factors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D055815:Young Adult
keywords: acute rejection; new onset diabetes after transplant; pediatric kidney transplant; pediatric transplantation; rejection