Effect of post-transplant glycemic control on long-term clinical outcomes in kidney transplant recipients with diabetic nephropathy: A multicenter cohort study in Korea

Yong Chul Kim,Dong-Wan Chae,Jung Pyo Lee,Sunhwa Lee,Nara Shin,Su-Kil Park,Hyosang Kim,Young Hoon Kim,Huh Hyuk,Jongwon Ha,Jang-Hee Cho,Yon Su Kim,Chan-Duck Kim,Francesca D'Addio

doi:10.1371/journal.pone.0195566

Abstract

PurposeDiabetic nephropathy is the leading cause of end stage renal disease. The number of kidney transplantation (KT) due to diabetic nephropathy is increasing and there is debate on glycemic control after KT. In this study, we used a multi-center database to determine the relationship between post-transplant glycemic control and the outcomes of KT in patients with diabetic nephropathy.MethodsWe conducted a retrospective chart review of kidney transplant recipients (KTRs) with diabetic nephropathy from three tertiary hospitals to analyze the association between post-transplant glycemic control and the clinical outcomes of graft failure, including patient death and biopsy-proven acute rejection (BPAR). We assessed time-averaged glucose level and hemoglobin A1c (HbA1c) for 36 months after KT.ResultsAmong 3,538 KTRs, a total of 476 patients received kidney transplantation because of diabetic nephropathy. Mean time-averaged glucose and HbA1c levels were 147 ± 46 mg/dl and 7.7 ± 1.5%, respectively. Patients with diabetic nephropathy had poor graft and patient survival rate compared with non-diabetic nephropathy. Among KTRs with diabetic nephropathy, the highest quartile of time-averaged glucose was related to poor graft outcomes and the 3rd quartile of time-averaged HbA1c was associated with significantly better graft outcomes than the 1st, 2nd or 4th quartiles. There were no significant differences in the risk of BPAR across the 4 quartiles of glucose and HbA1c.ConclusionsStrict glycemic control before KT might not be related to successful outcomes but poor glycemic control after KT is associated with poor graft outcomes. There was no significant relationship between pre- or post-transplant glycemic control and BPAR.

Highlights

Diabetic nephropathy is the leading cause of end stage renal disease (ESRD)
We conducted a retrospective chart review of kidney transplant recipients (KTRs) with diabetic nephropathy from three tertiary hospitals to analyze the association between posttransplant glycemic control and the clinical outcomes of graft failure, including patient death and biopsy-proven acute rejection (BPAR)
Patients with diabetic nephropathy had poor graft and patient survival rate compared with non-diabetic nephropathy

Summary

Introduction

Diabetic nephropathy is the leading cause of end stage renal disease (ESRD). In the United States Renal Data System (USRDS) 2013 annual report, diabetes was the most common cause of ESRD at nearly 50% of total incident dialysis [1]. There are three choices for renal replacement therapy (RRT): hemodialysis, peritoneal dialysis and kidney transplantation. Hemodialysis is the most common RRT modality, the rate of kidney transplantation is on the rise. When compared to hemodialysis, kidney transplantation in patients with diabetic nephropathy (DN) is associated with better outcomes in terms of both mortality and cardiovascular complications such as coronary artery and peripheral vascular events [2,3]. In the United States, the prevalence of DN in kidney transplantation patients was 27.6% in 2002 and 28.9% in 2012; DN was the main cause of primary renal disease [4]

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