Article

Diabetologia

, Volume 54, Issue 6, pp 1341-1349

Open Access This content is freely available online to anyone, anywhere at any time.

The association of early post-transplant glucose levels with long-term mortality

  • T. G. ValderhaugAffiliated withSection for Nephrology, Department for Organ Transplantation, Gastroenterology and Nephrology, Division for Specialized Medicine and Surgery, Oslo University Hospital, RikshospitaletInstitute of Clinical Medicine, Faculty Division Rikshospitalet, University of OsloDepartment of Thoracic and Cardiovascular Surgery, Oslo University Hospital, Rikshospitalet Email author 
  • , J. HjelmesæthAffiliated withMorbid Obesity Centre, Vestfold Hospital Trust
  • , A. HartmannAffiliated withSection for Nephrology, Department for Organ Transplantation, Gastroenterology and Nephrology, Division for Specialized Medicine and Surgery, Oslo University Hospital, RikshospitaletInstitute of Clinical Medicine, Faculty Division Rikshospitalet, University of Oslo
  • , J. RøislienAffiliated withMorbid Obesity Centre, Vestfold Hospital TrustDepartment of Biostatistics, Institute of Basic Medical Science, University of Oslo
  • , H. A. BergremAffiliated withSection for Nephrology, Department for Organ Transplantation, Gastroenterology and Nephrology, Division for Specialized Medicine and Surgery, Oslo University Hospital, Rikshospitalet
  • , T. LeivestadAffiliated withInstitute of Immunology, Oslo University Hospital, Rikshospitalet
  • , P. D. LineAffiliated withSection for Transplantation Surgery, Department for Organ Transplantation, Gastroenterology and Nephrology, Division for Specialized Medicine and Surgery, Oslo University Hospital, Rikshospitalet
  • , T. JenssenAffiliated withSection for Nephrology, Department for Organ Transplantation, Gastroenterology and Nephrology, Division for Specialized Medicine and Surgery, Oslo University Hospital, RikshospitaletInstitute of Clinical Medicine, University of Tromsø

Abstract

Aims/objective

We aimed to assess the long-term effects of post-transplant glycaemia on long-term survival after renal transplantation.

Methods

Study participants were 1,410 consecutive transplant recipients without known diabetes who underwent an OGTT 10 weeks post-transplant and were observed for a median of 6.7 years (range 0.3–13.8 years). The HRs adjusted for age, sex, traditional risk factors and transplant-related risk factors were estimated.

Results

Each 1 mmol/l increase in fasting plasma glucose (fPG) or 2 h plasma glucose (2hPG) was associated with 11% (95% CI −1%, 24%) and 5% (1%, 9%) increments in all-cause mortality risk and 19% (1%, 39%) and 6% (1%, 12%) increments in cardiovascular (CV) mortality risk, respectively. Including both fPG and 2hPG in the multi-adjusted model the HR for 2hPG remained unchanged, while the HR for fPG was attenuated (1.05 [1.00, 1.11] and 0.97 [0.84, 1.14]). Compared with recipients with normal glucose tolerance, patients with post-transplant diabetes mellitus had higher all-cause and CV mortality (1.54 [1.09, 2.17] and 1.80 [1.10, 2.96]), while patients with impaired glucose tolerance (IGT) had higher all-cause, but not CV mortality (1.39 [1.01, 1.91] and 1.04 [0.62, 1.74]). Conversely, impaired fasting glucose was not associated with increased all-cause or CV mortality (0.79 [0.52, 1.23] and 0.76 [0.39, 1.49]). Post-challenge hyperglycaemia predicted death from any cause and infectious disease in the multivariable analyses (1.49 [1.15, 1.95] and 1.91 [1.09, 3.33]).

Conclusions/interpretation

For predicting all-cause and CV mortality, 2hPG is superior to fPG after renal transplantation. Also, early post-transplant diabetes, IGT and post-challenge hyperglycaemia were significant predictors of death. Future studies should determine whether an OGTT helps identify renal transplant recipients at increased risk of premature death.

Keywords

Mortality after renal transplantation New-onset post-transplant diabetes mellitus Oral glucose tolerance test Post-transplant complications