Pretransplant diabetes is a major predictor of all-cause and cardiovascular (CV) mortality among renal transplant recipients surviving with a functioning graft for at least one year, according to study findings published in the American Journal of Kidney Diseases (2010;56:1127-1138). Acute rejection during the first year is a major predictor of death-censored transplant failure.
The findings emerged from a study of 37,448 transplant recipients who were alive with a functioning graft for longer that one year. Investigators led by Suphamai Bunnapradist, MD, of The David Geffen School of Medicine at UCLA divided subjects into six groups: patients with neither diabetes nor acute rejection at one year (group 1, reference); new-onset diabetes alone (group 2); those with pretransplant diabetes alone (group 3); subjects with acute rejection alone (group 4); those with new-onset diabetes and acute rejection (group 5); and patients with pretransplant diabetes and acute rejection (group 6).
The median follow-up after one year was 548 days. New-onset diabetes was not significantly associated with transplant failure (overall and death-censored) or all-cause or CV mortality. Patients in groups 3-6 had a higher overall transplant failure risk. Those in groups 4-6 had an increased death-censored transplant failure risk. Subjects in groups 3, 4, and 6 had higher all-cause mortality risk but only groups 3 and 6 had higher CV mortality risk.