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Meta-Analysis
. 2025 Feb 28;40(3):554-576.
doi: 10.1093/ndt/gfae185.

Prognostic impact of post-transplant diabetes mellitus in kidney allograft recipients: a meta-analysis

Mehmet Kanbay  1 , Dimitrie Siriopol  2   3 , Mustafa Guldan  4 , Lasin Ozbek  4 , Ahmet U Topcu  4 , Ianis Siriopol  5   6 , Katherine Tuttle  7
Affiliations
Meta-Analysis

Prognostic impact of post-transplant diabetes mellitus in kidney allograft recipients: a meta-analysis

Mehmet Kanbay et al. Nephrol Dial Transplant. .

Abstract

Background: Post-transplant diabetes mellitus (PTDM) is a complex condition arising from various factors including immunosuppressive medications, insulin resistance, impaired insulin secretion and inflammatory processes. Its impact on patient and graft survival is a significant concern in kidney transplant recipients. PTDM's impact on kidney transplant recipients, including patient and graft survival and cardiovascular mortality, is a significant concern, given conflicting findings in previous studies. This meta-analysis was imperative not only to incorporate emerging evidence but also to delve into cause-specific mortality considerations. We aimed to comprehensively evaluate the association between PTDM and clinical outcomes, including all-cause and cardiovascular mortality, sepsis-related mortality, malignancy-related mortality and graft loss, in kidney transplant recipients.

Methods: PubMed, Ovid/Medline, Web of Science, Scopus and Cochrane Library databases were screened and studies evaluating the effect of PTDM on all-cause mortality, cardiovascular mortality, sepsis-related mortality, malignancy-related mortality and overall graft loss in adult kidney transplant recipients were included.

Results: Fifty-three studies, encompassing a total of 138 917 patients, evaluating the association between PTDM and clinical outcomes were included. Our analysis revealed a significant increase in all-cause mortality [risk ratio (RR) 1.70, 95% confidence interval (CI) 1.53 to 1.89, P < .001] and cardiovascular mortality (RR 1.86, 95% CI 1.36 to 2.54, P < .001) among individuals with PTDM. Moreover, PTDM was associated with a higher risk of sepsis-related mortality (RR 1.96, 95% CI 1.51 to 2.54, P < .001) but showed no significant association with malignancy-related mortality (RR 1.20, 95% CI 0.76 to 1.88). Additionally, PTDM was linked to an increased risk of overall graft failure (RR 1.33, 95% CI 1.16 to 1.54, P < .001).

Conclusion: These findings underscore the importance of comprehensive management strategies and the need for research targeting PTDM to improve outcomes in kidney transplant recipients.

Keywords: graft loss; kidney transplantation; mortality; new onset diabetes after transplantation; post-transplant diabetes mellitus.

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Conflict of interest statement

K.T. is supported by National Institutes of Health (NIH) research grants R01MD014712, U2CDK114886, UL1TR002319, U54DK083912, U01DK100846, OT2HL161847, UM1AI109568 and OT2OD032581, and CDC project numbers 75D301-21-P-12254 and 75D301-23-C-18264. She has also received investigator-initiated grant support from Travere, Bayer, and the Doris Duke Foundation outside of the submitted work. She reports consultancy fees from Boehringer Ingelheim, Eli Lilly and Company, and Novo Nordisk, and speaker fees from Novo Nordisk. The other authors have no conflicts of interest.

Figures

Figure 1:
Figure 1:
Flow diagram of the study selection process.
Figure 2:
Figure 2:
Meta-analysis of PTDM and the risk of all-cause mortality.
Figure 3:
Figure 3:
Meta-analysis of PTDM and the risk of cardiovascular mortality.
Figure 4:
Figure 4:
Meta-analysis of PTDM and the risk of sepsis-related mortality.
Figure 5:
Figure 5:
Meta-analysis of PTDM and the risk of malignancy-related mortality.
Figure 6:
Figure 6:
Meta-analysis of PTDM and the risk of graft loss.
See this image and copyright information in PMC

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References

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