Infection-related mortality is higher for kidney allograft recipients with pretransplant diabetes mellitus
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The risk of infection-related mortality in kidney allograft recipients with pre-existing diabetes mellitus is unknown. We determined the risk of infection-related mortality after kidney transplantation in a population-based cohort stratified by diagnosis of pre-existing diabetes mellitus.
We linked data between two national registries (Hospital Episode Statistics and the Office for National Statistics) to select all mortality events after kidney transplantation in England between April 2001 and March 2012. The primary outcome measure was infection-related mortality after transplantation comparing diabetic with non-diabetic recipients.
A total of 19,103 kidney allograft recipients were analysed; 2,968 (15.5%) were known to have diabetes before kidney transplantation. After transplantation, 2,085 deaths (10.9%) occurred (median follow-up 4.4 years [interquartile range 2.2–7.3]), with 434 classified as secondary to infection (20.8% of all deaths). Risk of overall (16.0% vs 10.0%, p < 0.001) and infection-related (3.3% vs 2.1%, p < 0.001) mortality after kidney transplantation was higher for diabetic than non-diabetic recipients, respectively. No cytomegalovirus-related deaths occurred in diabetic recipients compared with 5.7% in non-diabetic recipients (p < 0.007), with a trend towards more unspecified sepsis in diabetic recipients (30.6% vs 22.6%, respectively, p = 0.070). Diabetes at the time of transplantation was an independent risk factor predicting infection-related mortality in kidney allograft recipients after transplantation (HR 1.71 [95% CI 1.36, 2.15], p < 0.001).
Infection-related mortality is more common in kidney allograft recipients with pre-existing diabetes mellitus. Further work is required to determine whether attenuated immunosuppression is beneficial for diabetic kidney allograft recipients.
KeywordsCytomegalovirus Diabetes mellitus Infection Kidney allograft Kidney transplantation Mortality Sepsis
End-stage renal disease
Hospital Episode Statistics
Office for National Statistics
Office of Population Censuses and Surveys Classification of Interventions and Procedures, 4th revision
We thank S. Sutherland (Queen Elizabeth Hospital, Birmingham, UK) and J. Cheshire (University of Birmingham, UK) for their assistance in data classification as part of our analyses.
This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Duality of interest
The authors declare that there is no duality of interest associated with this manuscript.
All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data. MKH, DF, IB, DR and AS were involved with drafting the article or revising it critically for important intellectual content; and all authors have given final approval of the version to be published.
- 11.US Renal Data System (2012) USRDS 2011 annual data report: atlas of chronic kidney disease and end-stage renal disease in the United States. Am J Kidney Dis 59(Suppl 1):e1–e420Google Scholar
- 13.Koh GC, Peacock SJ, van der Poll T, Wiersinga WJ (2012) The impact of diabetes on the pathogenesis of sepsis. Eur J Clin Microbiol Infect Dis 31:379–388Google Scholar
- 16.OPCS-4 classification – NHS Connecting for Health. Available from www.connectingforhealth.nhs.uk. Accessed 12 June 2013
- 17.World Health Organization: International Classification of Diseases (ICD). Available from www.who.int/classifications/icd/en. Accessed 5 June 2013
- 18.Department for Communities and Local Government. The English Indices of Deprivation 2010. Available from www.gov.uk/government/publications/english-indices-of-deprivation-2010. Accessed17 June 2013
- 32.Leung Ki EL, Venetz JP, Meylan P, Lamoth F, Ruiz J, Pascual M (2008) Cytomegalovirus infection and new-onset diabetes after transplantation. Clin Transplant 22:245–249Google Scholar