June 2011, Volume 54, Issue 6, pp 1341-1349,
Open Access This content is freely available online to anyone, anywhere at any time.
Date: 16 Mar 2011
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.
T. G. Valderhaug and J. Hjelmesæth contributed equally to this study.
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- 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