Post-transplant diabetes and long-term outcomes after kidney transplantation in a steroid-avoidance regimen
Post-transplant diabetes mellitus (PTDM) is a metabolic complication of kidney transplantation that leads to a decline in eGFR function. Defined as new-onset and persistent hyperglycaemia 3 months after transplant and present for >6 months, PTDM is associated with reduced recipient survival and death-censored graft survival. It has also been linked to steroid use and obesity.
Immunosuppressant regimens that avoid or minimise steroids have subsequently evolved and are widely used. While studies have demonstrated their safety over relatively short follow-up periods, concerns about acute rejection remain, and confidence in them remains low.
Gardiner and colleagues conducted a retrospective cohort study to describe the incidence of PTDM and identify risk factors of PTDM in recipients of first kidney transplantation following a steroid-avoidance regimen over an 11-year period. Death-censored graft and patient survival was also assessed.
A dataset from 1053 individuals who underwent kidney transplantation from 2010–2021 at a single centre in Leeds was extracted. Of the 577 who met the inclusion criteria, 55 (10%) whose allograft lasted ≥5 years developed PTDM during a median follow-up of 7.1 years (range, 0.9–13.8 years). The incidence among those with no prior history of diabetes was 16%. Of those 55 patients, 37 (67%) were categorised within 1 year of transplantation, 7 (13%) between 1 and 2 years and 11 (20%) after the end of the second year.
After adjusting for confounding factors, increasing baseline BMI and non-white ethnicity were associated with greater risk of developing PTDM despite steroid avoidance. No statistically significant associations were found for age, sex, hypertension or weight gain.
Across all individuals, the 10-year survival rate was 76% (78% in those without diabetes before transplant, 73% for those with preceding diabetes and 68% for those with PTDM). Functioning grafts were recorded in 80% of the cohort at 10 years, including 79% of those with PTDM and 74% of those with preceding diabetes. There were no statistically significant differences in patient or graft survival based on diabetes status, although the subgroups were relatively small.
The authors conclude that these findings support the efficacy of the use of a steroid-avoidance regimen in kidney transplant recipients. The risk of PTDM onset in relation to high BMI suggests that the management of weight and lifestyle should be considered in high-risk groups before and after transplantation.
The full article can be read here.
