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Pre‐existing diabetes is a risk factor for increased rates of cellular rejection after kidney transplantation: an observational cohort study
Author(s) -
Johal S.,
JacksonSpence F.,
Gillott H.,
Tahir S.,
Mytton J.,
Evison F.,
Stephenson B.,
Nath J.,
Sharif A.
Publication year - 2017
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.13383
Subject(s) - medicine , diabetes mellitus , kidney transplantation , hazard ratio , immunosuppression , transplantation , proportional hazards model , risk factor , cohort , cohort study , retrospective cohort study , kidney , endocrinology , confidence interval
Aim To investigate whether people with diabetes have an elevated risk of kidney allograft rejection in a well characterized clinical cohort in the setting of contemporary immunosuppression. Methods We conducted a retrospective cohort study including all kidney allograft recipients at a single centre between 2007 and 2015, linking clinical, biochemical and histopathological data from electronic patient records. Results Data were analysed for 1140 kidney transplant recipients. The median follow‐up was 4.4 years post‐transplantation, and 117 of the kidney transplant recipients (10.2%) had diabetes at time of transplantation. Kidney allograft recipients with vs without diabetes were older (53 vs 45 years; P <0.001) and more likely to be non‐white (41.0% vs 26.4%; P =0.001). Kidney allograft recipients with vs without diabetes had a higher risk of cellular rejection (19.7% vs 12.4%; P =0.024), but not of antibody‐mediated rejection (3.4% vs 3.7%; P =0.564). Graft function and risk of death‐censored graft loss were similar in the two groups, but kidney allograft recipients with diabetes had a higher risk of death and overall graft loss than those without diabetes. In a Cox regression model of non‐modifiable risk factors at time of transplantation, diabetes was found to be an independent risk factor for cellular rejection (hazard ratio 1.445, 95% CI 1.023–1.945; P =0.042). Conclusions Kidney allograft recipients with diabetes at transplantation should be counselled regarding their increased risk of cellular rejection but reassured regarding the lack of any adverse impact on short‐to‐medium term allograft function or survival.