Kidney transplant recipients with diabetes, whether pre-existing or developed post-transplant, face a significantly higher risk of mortality following graft loss compared to those without diabetes. A recent study, led by Amali Samarasinghe, analysed data from 3,782 kidney transplant recipients who experienced their first graft loss, using information gathered from the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA). Of these patients, 14% had diabetes prior to their transplant, and 10% developed diabetes post-transplant.
Results showed that over an average follow-up period of 2.7 years, 1,336 patients (35%) died. The causes of death included cardiovascular disease (32%), dialysis withdrawal (20%), and infection (15%). The analysis revealed that patients with diabetes at the time of kidney allograft loss had a 47% higher risk of dying from any cause while on dialysis compared to those without diabetes. This increased risk was especially pronounced in younger patients (aged 50 years or younger), who had a 2.4-fold increase in all-cause mortality with pre-transplant diabetes and a 1.5-fold increase with post-transplant diabetes. For patients older than 50 years, post-transplant diabetes was associated with a 1.3-fold increase in death risk. The results also showed that infection-related mortality was 1.8-fold higher for pre-transplant diabetes and 2.7-fold higher for post-transplant diabetes. And the dialysis withdrawal-related mortality was 1.7-fold higher for pre-transplant diabetes and 1.5-fold higher for post-transplant diabetes. Cardiovascular-related mortality was initially comparable among all patients, but a higher rate was observed in those with pre-transplant diabetes before adjustments, indicating that the duration of diabetes might significantly affect cardiovascular survival on dialysis following graft loss.
The results suggest that the hyperglycaemic state in the post-transplant period may have a more detrimental effect on survival than previously understood, even for those with a shorter duration of diabetes. Additionally, the study pointed out that patients with diabetes were less likely to undergo re-transplantation compared to non-diabetic patients, which could further impact their long-term survival outcomes.
The study highlights the need for improved management strategies for diabetes and cardiovascular risk factors in kidney transplant recipients, particularly among younger patients. Addressing these risks could potentially mitigate the higher mortality associated with diabetes in this vulnerable patient population. This research emphasises the importance of continued investigation into the mechanisms underlying this survival disparity to enhance patient care and outcomes.
Aleksandra Zurowska, EMJ
Reference:
Samarasinghe A et al. Association between diabetic status and risk of all-cause and cause-specific mortality on dialysis following first kidney allograft loss. CKJ. 2024;17(3):sfad245.
