The association of early post-transplant glucose levels with long-term mortality
We aimed to assess the long-term effects of post-transplant glycaemia on long-term survival after renal transplantation.
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.
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]).
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.
- The association of early post-transplant glucose levels with long-term mortality
- Open Access
- Available under Open Access This content is freely available online to anyone, anywhere at any time.
Volume 54, Issue 6 , pp 1341-1349
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Mortality after renal transplantation
- New-onset post-transplant diabetes mellitus
- Oral glucose tolerance test
- Post-transplant complications
- Industry Sectors
- Author Affiliations
- 1. Section for Nephrology, Department for Organ Transplantation, Gastroenterology and Nephrology, Division for Specialized Medicine and Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- 2. Institute of Clinical Medicine, Faculty Division Rikshospitalet, University of Oslo, Oslo, Norway
- 3. Department of Thoracic and Cardiovascular Surgery, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, 0027, Oslo, Norway
- 4. Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway
- 5. Department of Biostatistics, Institute of Basic Medical Science, University of Oslo, Oslo, Norway
- 6. Institute of Immunology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- 7. Section for Transplantation Surgery, Department for Organ Transplantation, Gastroenterology and Nephrology, Division for Specialized Medicine and Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- 8. Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway