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. 2008 May;3(3):814-21.
doi: 10.2215/CJN.04681107. Epub 2008 Mar 5.

Impact of acute rejection and new-onset diabetes on long-term transplant graft and patient survival

Edward H Cole  1 , Olwyn Johnston, Caren L Rose, John S Gill
Affiliations

Impact of acute rejection and new-onset diabetes on long-term transplant graft and patient survival

Edward H Cole et al. Clin J Am Soc Nephrol. 2008 May.

Abstract

Background and objectives: Development of new therapeutic strategies to improve long-term transplant outcomes requires improved understanding of the mechanisms by which these complications limit long-term transplant survival.

Design, setting, participants, & measurements: The association of acute rejection and new-onset diabetes was determined in the first posttransplantation year with the outcomes of transplant failure from any cause, death-censored graft loss, and death with a functioning graft in 27,707 adult recipients of first kidney-only transplants, with graft survival of at least 1 yr, performed between 1995 and 2002 in the United States.

Results: In multivariate analyses, patients who developed acute rejection or new-onset diabetes had a similar risk for transplant failure from any cause, but the mechanisms of transplant failure were different: Acute rejection was associated with death-censored graft loss but only weakly associated with death with a functioning graft. In contrast new-onset diabetes was not associated with death-censored graft loss but was associated with an increased risk for death with a functioning graft.

Conclusions: Acute rejection and new-onset diabetes have a similar impact on long-term transplant survival but lead to transplant failure through different mechanisms. The mechanisms by which new-onset diabetes leads to transplant failure should be prospectively studied. Targeted therapeutic strategies to minimize the impact of various early posttransplantation complications may lead to improved long-term outcomes.

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Figures

Figure 1.
Figure 1.
Rate of acute rejection (AR) and new-onset diabetes (NODM) in first posttransplantation year by transplant era.
Figure 2.
Figure 2.
Time to transplant failure from any cause.
Figure 3.
Figure 3.
Time to death censored graft loss and death with a functioning graft.
Figure 4.
Figure 4.
Patient survival, including survival on dialysis after transplant failure.
See this image and copyright information in PMC

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