The association of early post-transplant glucose levels with long-term mortality

• Published in: Diabetologia 2011-06, Vol.54 (6), p.1341-1349
• Main Authors: Valderhaug, T. G., Hjelmesæth, J., Hartmann, A., Røislien, J., Bergrem, H. A., Leivestad, T., Line, P. D., Jenssen, T.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biological and medical sciences; Blood Glucose - metabolism; Cardiovascular Diseases - mortality; Clinical medical disciplines: 750; Clinical medicine; Cohort analysis; Community medicine, Social medicine: 801; Diabetes; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinology: 774; Endocrinopathies; Endokrinologi: 774; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Fasting - blood; Female; Gastroenterology; Glucose; Glucose Tolerance Test; Health sciences: 800; Helsefag: 800; Hospitals; Human Physiology; Humans; Hyperglycemia; Hyperglycemia - blood; Infectious diseases; Internal Medicine; Kidney Transplantation - mortality; Kidney transplants; Klinisk medisinske fag: 750; Longitudinal Studies; Male; Medical disciplines: 700; Medical sciences; Medicine; Medicine & Public Health; Medisinske Fag: 700; Metabolic Diseases; Middle Aged; Mortality; Nefrologi, urologi: 772; Nephrology; Nephrology, urology: 772; Plasma; Predictive Value of Tests; Proportional Hazards Models; Prospective Studies; Retrospective Studies; Risk Factors; Samfunnsmedisin, sosialmedisin: 801; Surgery; Survival Rate; Time Factors; VDP
• ISSN: 0012-186X; 1432-0428
• DOI: 10.1007/s00125-011-2105-9

Aims/objective We aimed to assess the long-term effects of post-transplant glycaemia on long-term survival after renal transplantation. Methods Study participants were 1,410 consecutive transplant recipients without known diabetes who underwent an OGTT 10 weeks post-transplant and were observed for a median of 6.7 years (range 0.3–13.8 years). The HRs adjusted for age, sex, traditional risk factors and transplant-related risk factors were estimated. Results Each 1 mmol/l increase in fasting plasma glucose (fPG) or 2 h plasma glucose (2hPG) was associated with 11% (95% CI −1%, 24%) and 5% (1%, 9%) increments in all-cause mortality risk and 19% (1%, 39%) and 6% (1%, 12%) increments in cardiovascular (CV) mortality risk, respectively. Including both fPG and 2hPG in the multi-adjusted model the HR for 2hPG remained unchanged, while the HR for fPG was attenuated (1.05 [1.00, 1.11] and 0.97 [0.84, 1.14]). Compared with recipients with normal glucose tolerance, patients with post-transplant diabetes mellitus had higher all-cause and CV mortality (1.54 [1.09, 2.17] and 1.80 [1.10, 2.96]), while patients with impaired glucose tolerance (IGT) had higher all-cause, but not CV mortality (1.39 [1.01, 1.91] and 1.04 [0.62, 1.74]). Conversely, impaired fasting glucose was not associated with increased all-cause or CV mortality (0.79 [0.52, 1.23] and 0.76 [0.39, 1.49]). Post-challenge hyperglycaemia predicted death from any cause and infectious disease in the multivariable analyses (1.49 [1.15, 1.95] and 1.91 [1.09, 3.33]). Conclusions/interpretation For predicting all-cause and CV mortality, 2hPG is superior to fPG after renal transplantation. Also, early post-transplant diabetes, IGT and post-challenge hyperglycaemia were significant predictors of death. Future studies should determine whether an OGTT helps identify renal transplant recipients at increased risk of premature death.