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. 2021 May;9(1):e001962.
doi: 10.1136/bmjdrc-2020-001962.

Long-term mortality among kidney transplant recipients with and without diabetes: a nationwide cohort study in the USA

Jessica L Harding  1   2 , Meda Pavkov  3 , Zhensheng Wang  2 , Stephen Benoit  3 , Nilka Ríos Burrows  3 , Giuseppina Imperatore  3 , Ann L Albright  3 , Rachel Patzer  4   2
Affiliations

Long-term mortality among kidney transplant recipients with and without diabetes: a nationwide cohort study in the USA

Jessica L Harding et al. BMJ Open Diabetes Res Care. 2021 May.

Abstract

Introduction: Little is known about the role diabetes (type 1 (T1D) and type 2 (T2D)) plays in modifying prognosis among kidney transplant recipients. Here, we compare mortality among transplant recipients with T1D, T2D and non-diabetes-related end-stage kidney disease (ESKD).

Research design and methods: We included 254 188 first-time single kidney transplant recipients aged ≥18 years from the US Renal Data System (2000-2018). Diabetes status, as primary cause of ESKD, was defined using International Classification of Disease 9th and 10th Clinical Modification codes. Multivariable-adjusted Cox regression models (right-censored) computed risk of death associated with T1D and T2D relative to non-diabetes. Trends in standardized mortality ratios (SMRs) (2000-2017), relative to the general US population, were assessed using Joinpoint regression.

Results: A total of 72 175 (28.4%) deaths occurred over a median survival time of 14.6 years. 5-year survival probabilities were 88%, 85% and 77% for non-diabetes, T1D and T2D, respectively. In adjusted models, mortality was highest for T1D (HR=1.95, (95% CI: 1.88 to 2.03)) and then T2D (1.65 (1.62 to 1.69)), as compared with non-diabetes. SMRs declined for non-diabetes, T1D, and T2D. However, in 2017, SMRs were 2.38 (2.31 to 2.45), 6.55 (6.07 to 7.06), and 3.82 (3.68 to 3.98), for non-diabetes, T1D and T2D, respectively.

Conclusions: In the USA, diabetes type is an important modifier in mortality risk among kidney transplant recipients with highest rates among people with T1D-related ESKD. Development of effective interventions that reduce excess mortality in transplant recipients with diabetes is needed, especially for T1D.

Keywords: diabetes mellitus type 1; diabetes mellitus type 2; epidemiology; kidney transplantation.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Failure probabilities and rates for mortality (A) and graft failure* (B), respectively, by primary cause of ESKD (non-diabetes, type 1 and type 2 diabetes). *Cumulative incidence function is reported for graft failure to account for the competing risk of death. ESKD, end-stage kidney disease.
Figure 2
Figure 2
Standardized mortality ratios comparing year and age-matched mortality rates in the transplant versus general US populations, by diabetes status, 2000–2017; *ptrend <0.05. APC, annual percentage change.
See this image and copyright information in PMC

Comment in

  • Renal transplant outcomes and diabetes.
    Weinrauch LA, D'Elia JA. Weinrauch LA, et al. BMJ Open Diabetes Res Care. 2021 May;9(1):e002294. doi: 10.1136/bmjdrc-2021-002294. BMJ Open Diabetes Res Care. 2021. PMID: 33962974 Free PMC article. No abstract available.

References

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