PUK4 COMPARISON OF POSTTRANSPLANT NEW-ONSET DIABETES AND CANCER BETWEEN PERITONEAL AND HEMODIALYSIS RECIPIENTS: RESULTS OF A PROPENSITY-MATCHED COHORT STUDY

Abstract

most renal transplant recipients are vulnerable to new-onset diabetes and newly-developed cancer as a complication of their procedure and aggressive immunosuppressant therapy. Currently, an increasing effort to determine the underlying factors and effective prevention for such complications. However, type of pretransplant dialysis modality as a predictor was hardly evaluated. To compare post-TX new-onset diabetes and cancer between pretransplant HD and PD for adults with ESRD in the US. A propensity-matched retrospective study of renal recipients between January 2007 and December 2011, following ≥60 days of maintenance dialysis. All the data were obtained from the USRDS for the period 2006 to 2012. Adults who received either kidney or kidney/pancreas, with ≥6 months of pre-TX history were included. Patients with other organ transplants, two or more prior renal TXs, and missing data were excluded. Incidence density rates (IDR) and rate differences (R-Diff.) along with Cox proportional hazard analyses were used. Our p-value was adjusted using Bonferroni correction for multiple comparisons. A total of 19,612 renal recipients (9,806 pairs) were included. No difference in follow-up (HD=36.51 vs PD=36.08 months, p-value =0.0807). Nearly, 50% of recipients had 2-18 months of pretransplant dialysis. PD recipients showed significantly more IDR of new-onset diabetes (R-Diff. =5.84/1000 person-year) and cancer (R-Diff. =6.18/1000 person-year). Adjusted Cox analyses indicated a nonsignificant hazard of new-onset diabetes (p-value =0.4140) and a significant hazard of cancer among PD recipients (p-value =0.0357). Renal recipients who were ≥ 50 years old, hypertensive, publicly insured, received a cadaveric organ, and those administered steroids as initial immunosuppressant showed significantly higher hazards for developing post-TX diabetes and cancer. Over the 6-year period, PD patients exhibited higher incidence rates of diabetes and cancer. Upon adjusting for other factors, PD had a significant hazard of developing cancer but not diabetes compared to hemodialysis patients.