New-onset diabetes tied to increased mortality risk among transplant recipients

  • Chanchlani R & al.
  • Nephrol Dial Transplant
  • 30 Jul 2018

  • from Sarfaroj Khan
  • Clinical Summaries
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Takeaway

  • Children with solid organ transplant (SOT) were at increased risk for diabetes compared with non-transplanted children.
  • Risk was higher within the first year of transplant and persisted even a decade after transplantation; posttransplant diabetes significantly increased mortality risk in children with SOT.

Why this matter

  • Although the risk for diabetes in SOT recipients is higher in the first few years after transplant, the magnitude and direction of the long-term risk for new-onset diabetes and their effect on mortality in children with SOT are unknown.

Study design

  • Cohort study compared 1020 children who underwent SOT with 71,34,067 non-transplanted children between 1991 and 2014.
  • Outcomes included diabetes incidence among transplanted and non-transplanted children.
  • Funding: Transplant & Regenerative Medicine Centre.

Results

  • During 5,60,19,824 person-years of follow-up, the incidence rates of diabetes were higher in children with transplant vs those without transplant (incidence rate [IR], 17.8/1000 person-years; 95% CI, 15-21 vs 2.5/1000 person-years, 95% CI, 2.5-2.5).
  • Children with transplant had a 9-fold higher risk for diabetes vs those without transplant (HR, 8.9; 95% CI, 7.5-10.5).
  • Risk was highest in the first year after transplant (HR, 20.7; 95% CI, 15.9-27.1) and remained elevated even at 5 and 10 years of follow-up.
  • Children with lung and multiple organ transplant had a 5-fold higher risk for diabetes vs those with kidney transplant (HR, 5.4; 95% CI, 3.0-9.8).
  • Transplant cohorts with diabetes were at 3 times higher risk for mortality vs those without diabetes (aHR, 3.3; 95% CI, 2.3-4.8).

Limitations

  • Lack of information on diabetes risk factor.
  • Misclassification bias.