Patient survival after renal transplantation: IV. Impact of post-transplant diabetes
Patient survival after renal transplantation: IV. Impact of post-transplant diabetes
复制标题
DOI：
10.1111/j.1523-1755.2002.kid582.x
复制
发表时间：
2002-10-01
影响因子：
19.6
通讯作者：
Ferguson, RM
中科院分区：
文献类型：
--
作者：
Cosio, FG;Pesavento, TE;Ferguson, RM
背景。新发糖尿病是肾移植的严重并发症。本研究检查了移植后糖尿病 (PTDM) 患者的心血管风险状况，并评估了 PTDM 对患者生存的影响。方法。该分析包括 1811 名成人同种异体肾移植受者，他们于 1983 年至 1998 年间在单一机构进行移植。通过单变量和多变量 Cox 回归分析患者生存情况，将 PTDM 视为时间因变量。结果。经过 8.3 +/- 4.5 年的随访，293 名患者 (20%) 发展为 PTDM，14% 失去移植物，20% 死亡。与非 DM 患者 (NoDM，N = 1186) 相比，PTDM 患者年龄明显更大（40 +/- 14 岁 vs. 48 +/- 12 岁，P < 0.001），体重更重（76 +/- 23 vs. 86 +/- 25 kg，P < 0.001），并且包括更多非裔美国人（18% vs. 28%，P = 0.001）。此外，1995年后移植的患者PTDM的发生率明显高于当年之前。相比之下，PTDM 与移植前患有 DM 的患者 (DM；N = 332) 之间没有显着差异。与NoDM相比，PTDM患者在整个移植后期间的血清总胆固醇和甘油三酯（TG）、收缩压和脉压均显着升高。有趣的是，所有这些异常都发生在 PTDM 的发生之前。高甘油三酯血症在 PTDM 中尤其明显，并且 TG 水平升高与 PTDM 的后续发展相关，与其他危险因素无关（多变量 Cox 得出的 P = 0.001）。与 NoDM（死亡率为 16%）相比，DM（31%，P < 0.001）和 PTDM（22%，P = 0.005）患者的死亡百分比显着更高。通过 Cox 回归，PTDM 与患者生存率降低相关（风险比 = 1.80，CI 1.35 至 2.41，P = 0.001），并且该关系独立于生存率降低的其他相关因素，包括：年龄增加；移植年份；血清白蛋白降低；结论：PTDM 与发生高血糖之前的不利心血管风险状况相关。 PTDM 是同种异体肾移植受者生存率降低的独立预测因素。
Background. The development of de novo diabetes mellitus is a serious complication of kidney transplantation. This study examined the cardiovascular risk profile of patients with post-transplant diabetes (PTDM) and assessed the impact of PTDM on patient survival.Methods. This analysis included 1811 adult, renal allograft recipients, transplanted in a single institution between 1983 and 1998. Patient survival was analyzed by univariable and multivariable Cox regression considering PTDM as a time dependent variable.Results. After a follow-up period of 8.3 +/- 4.5 years, 293 patients (20%) developed PTDM, 14% lost their graft, and 20% died. Compared to patients without DM (NoDM, N = 1186) patients with PTDM were significantly older (40 +/- 14 vs. 48 +/- 12 years, P < 0.001), heavier (76 +/- 23 vs. 86 +/- 25 kg, P < 0.001), and included more African Americans (18 vs. 28%, P = 0.001). In addition, the incidence of PTDM was significantly higher in patients who were transplanted after 1995 than prior to that year. In contrast, there were no significant differences between PTDM and patients who had DM before the transplant (DM; N = 332). Compared to NoDM, patients with PTDM had significantly higher total serum cholesterol and triglycerides (TG), higher systolic blood pressure and higher pulse pressure throughout the post-transplant period. Of interest, all of these abnormalities preceded the development of PTDM. Hypertriglyceridemia was particularly pronounced in PTDM and elevated TG levels correlated with the subsequent development of PTDM, independent of other risk factors (P = 0.001 by multivariate Cox). Compared to NoDM (16% mortality) a significantly higher percent of DM (31%, P < 0.001) and PTDM (22%, P = 0.005) patients died. By Cox regression, PTDM correlated with reduced patient survival (hazard ratio = 1.80, CI 1.35 to 2.41, P = 0.001), and that relationship was independent of other correlates of reduced survival that included: increasing age; transplant year; reduced serum albumin; and male sex.Conclusions: PTDM is associated with an unfavorable cardiovascular risk profile that precedes the development of hyperglycemia. PTDM is an independent predictor of reduced survival in renal allograft recipients.