Diabetes Prior to Renal Transplantation Worsens Outcomes
Study results also shed light on possible ways to decrease the disparity in survival between kidney transplant patients with or without pre-existing DM.
A team at the Medical University of South Carolina in Charleston led by David J. Taber, MD, studied a cohort of 1,002 renal transplant recipients, of whom 302 had pre-existing DM. The cohort had a mean follow-up time of four years. The five-year graft and patient survival rates were significantly lower among patients with pre-existing DM than without it (74% vs. 79% and 83% vs. 93%, respectively), Dr. Taber's group reported online ahead of print in Clinical Transplantation. Pre-existing DM was associated with a significant 1.5 to 1.8 times increased risk of graft failure and a 2.3 to 3.0 times increased risk of death in analyses that adjusted for demographics, transplant characteristics, post-transplant events, and glycemic control. The increased risks became non-significant, however, after adjusting for cardiovascular disease (CVD) medication use.
“Although the results of this study require confirmation with randomized controlled trials,” the authors wrote, “they do suggest that focusing efforts on disease state management and use of CVD control risk factor control medications is an important component to optimizing outcomes in patients with pre-existing DM undergoing kidney transplant.”
The investigators concluded that their study confirms previous analyses and provides novel additions to the literature. It also suggests that the use of medications with compelling cardiovascular indications “may be one of the more important interventions to reduce the mortality disparity seen in DM kidney transplant recipients and that glycemic control may not have a strong influence on clinical outcomes in these patients.”