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Impact of antibody induction on the outcomes of new onset diabetes after kidney transplantation: a registry analysis

  • Nephrology - Original Paper
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Abstract

Purpose

We conducted this observational study to examine the impact of antibody inductions administered at kidney transplant (KT) on outcomes of 5 year exposure to post-transplant diabetes (PTDM) in adult deceased-donor kidney transplant recipients (DDKTRs). We also studied the risk of PTDM associated with antibody inductions.

Methods

Using 2000–2016 Organ Procurement Transplantation Network data, we employed multivariable Cox models to determine the adjusted hazard ratios (HR) of death, and overall and death-censored graft loss (OAGL, DCGL; respectively) at the 5 year landmark period in antibody induction cohorts with and without PTDM at the 1 year post-transplant index time point. We used multivariable logistic regression in determining the risk factors for PTDM. All multivariable analyses were adjusted for the potential confounding effects of maintenance immunosuppression, steroid regimens, and other relevant covariates.

Results

48,031 adult DDKTRs were classified into cohorts based on antibody induction at transplant: (anti-thymocyte globulin) ATG (n = 26, 788); (alemtuzumab) ALM (n = 5916); and interleukin-2 receptor antagonist (IL-2RA) (n = 15,327). PTDM was a risk factor for 5 year OAGL and death, not DCGL [(HR = 1.25, CI = 1.16–1.36), (HR = 1.13, CI = 1.06–1.21), and (HR = 1.05, CI = 0.96–1.16); respectively]. Induction regimens were not risk factors for 5 year outcomes in DDKTRs with and without PTDM. Risk factors for PTDM included DDKTR obesity, age > / = 50 years, acute rejection, and ATG induction, among others.

Conclusions

In adult DDKTRs, after controlling the confounding effects of clinically relevant variables including maintenance and steroid regimens, PTDM at 1 year post-transplant is associated with death and OAGL, not DCGL in the following 5 years: induction received at KT did not modify these associations.

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Acknowledgements

The data reported here have been supplied by the Minneapolis Medical Research Foundation as the contractor for the SRTR. The interpretation and reporting of these data are the responsibility of the authors and, in no way, should be an official policy of or interpretation by the SRTR or the U.S. Government. We acknowledge Mr. Jon A Gregg, MS for the statistical analysis of this study.

Funding

No funding was received to assist with the preparation of this manuscript.

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Authors and Affiliations

  1. Division of Nephrology, Hypertension, and Renal Transplantation, College of Medicine, University of Florida, 1600 SW Archer Road, Medical Science Bldg., Room NG-4, Gainesville, FL, 32610, USA

    Alfonso H. Santos Jr.

  2. Division of Nephrology, Hypertension, and Renal Transplantation, Department of Medicine, University of Florida, Gainesville, FL, USA

    Muhannad A. Leghrouz & Emma P. Bueno

  3. Division of Abdominal Transplantation, Department of Surgery, University of Florida, Gainesville, FL, USA

    Kenneth A. Andreoni

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  1. Alfonso H. Santos Jr.
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  2. Muhannad A. Leghrouz
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  3. Emma P. Bueno
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  4. Kenneth A. Andreoni
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Correspondence to Alfonso H. Santos Jr..

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Santos, A.H., Leghrouz, M.A., Bueno, E.P. et al. Impact of antibody induction on the outcomes of new onset diabetes after kidney transplantation: a registry analysis. Int Urol Nephrol 54, 637–646 (2022). https://doi.org/10.1007/s11255-021-02936-1

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