Pre‐existing diabetes is a risk factor for increased rates of cellular rejection after kidney transplantation: an observational cohort study
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...
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| Veröffentlicht in: | Diabetic medicine 2017-08, Vol.34 (8), p.1067-1073 |
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| container_title | Diabetic medicine |
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| creator | Johal, S. Jackson‐Spence, F. Gillott, H. Tahir, S. Mytton, J. Evison, F. Stephenson, B. Nath, J. Sharif, A. |
| description | 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 |
| doi_str_mv | 10.1111/dme.13383 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1899406928</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1919389041</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4193-a34ce25441b97d5b197415c5955c07de16b84424a10e11e5938932e0076366333</originalsourceid><addsrcrecordid>eNp10cFu1DAQBmALUdGlcOAFkCUucEjrie0k5laVUpCK4ADnaOJMwNtsvNgOsDeeAPGMPEmdbukBCUuWZfnTr7F-xp6AOIa8TvoNHYOUjbzHVqAqVWhl4D5biVqVhRQ1HLKHMa6FgNJI84Adlo0GIct6xX59CPTn52_64WJy02feO-woUeQucuTBxSs-oE0-8CFvN9lAGKnnARfkB25pHOcRAw-0JpucnzgOiQK_cv1EO54CTnE74pRweXzJceK-ixS-3dxx5NZ_8SHxmOZ-94gdDDhGenx7HrFPr88_nr0pLt9fvD07vSysAiMLlMpSqZWCztS97sDUCrTVRmsr6p6g6hqlSoUgCIC0kY2RJQlRV7KqpJRH7Pk-dxv815liajcuLl_BifwcW2iMUaIyZZPps3_o2s8hD56VgSVZKMjqxV7Z4GMMNLTb4DYYdi2IdimpzSW1NyVl-_Q2ce421N_Jv61kcLIH391Iu_8nta_ene8jrwEaT5y5</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1919389041</pqid></control><display><type>article</type><title>Pre‐existing diabetes is a risk factor for increased rates of cellular rejection after kidney transplantation: an observational cohort study</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Johal, S. ; Jackson‐Spence, F. ; Gillott, H. ; Tahir, S. ; Mytton, J. ; Evison, F. ; Stephenson, B. ; Nath, J. ; Sharif, A.</creator><creatorcontrib>Johal, S. ; Jackson‐Spence, F. ; Gillott, H. ; Tahir, S. ; Mytton, J. ; Evison, F. ; Stephenson, B. ; Nath, J. ; Sharif, A.</creatorcontrib><description>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.
What's new?
Diabetes remains the leading underlying cause of end‐stage kidney failure requiring kidney transplantation in developed countries.
Rejection of the kidney allograft is the most feared complication after kidney transplantation from a patient perspective, but it is unclear if patients with diabetes have an increased risk of this complication.
In this study, in the context of contemporary immunosuppression, we show that people with diabetes have an elevated risk of cellular rejection after kidney transplantation, but that this does not translate into adverse short‐to‐medium term kidney allograft outcomes.
Our data allow targeted risk counselling for people with diabetes who are awaiting kidney transplantation.</description><identifier>ISSN: 0742-3071</identifier><identifier>EISSN: 1464-5491</identifier><identifier>DOI: 10.1111/dme.13383</identifier><identifier>PMID: 28510327</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Adult ; Age Factors ; Cohort analysis ; Cohort Studies ; Combined Modality Therapy - adverse effects ; Data processing ; Death ; Diabetes ; Diabetes mellitus ; Diabetic Nephropathies - complications ; Diabetic Nephropathies - immunology ; Diabetic Nephropathies - surgery ; Diabetic Nephropathies - therapy ; Disease-Free Survival ; End-stage renal disease ; England - epidemiology ; Female ; Follow-Up Studies ; Graft rejection ; Graft Rejection - complications ; Graft Rejection - epidemiology ; Graft Rejection - immunology ; Graft Rejection - prevention & control ; Health risk assessment ; Hospitals, Teaching ; Humans ; Immunosuppression ; Immunosuppression - adverse effects ; Kidney diseases ; Kidney Failure, Chronic - complications ; Kidney Failure, Chronic - immunology ; Kidney Failure, Chronic - surgery ; Kidney Failure, Chronic - therapy ; Kidney transplantation ; Kidney Transplantation - adverse effects ; Kidney transplants ; Male ; Middle Aged ; Observational studies ; Proportional Hazards Models ; Renal failure ; Retrospective Studies ; Risk Factors ; Survival ; Transplantation ; Transplants & implants</subject><ispartof>Diabetic medicine, 2017-08, Vol.34 (8), p.1067-1073</ispartof><rights>2017 Diabetes UK</rights><rights>2017 Diabetes UK.</rights><rights>Diabetic Medicine © 2017 Diabetes UK</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4193-a34ce25441b97d5b197415c5955c07de16b84424a10e11e5938932e0076366333</citedby><cites>FETCH-LOGICAL-c4193-a34ce25441b97d5b197415c5955c07de16b84424a10e11e5938932e0076366333</cites><orcidid>0000-0002-7586-9136</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fdme.13383$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fdme.13383$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28510327$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Johal, S.</creatorcontrib><creatorcontrib>Jackson‐Spence, F.</creatorcontrib><creatorcontrib>Gillott, H.</creatorcontrib><creatorcontrib>Tahir, S.</creatorcontrib><creatorcontrib>Mytton, J.</creatorcontrib><creatorcontrib>Evison, F.</creatorcontrib><creatorcontrib>Stephenson, B.</creatorcontrib><creatorcontrib>Nath, J.</creatorcontrib><creatorcontrib>Sharif, A.</creatorcontrib><title>Pre‐existing diabetes is a risk factor for increased rates of cellular rejection after kidney transplantation: an observational cohort study</title><title>Diabetic medicine</title><addtitle>Diabet Med</addtitle><description>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.
What's new?
Diabetes remains the leading underlying cause of end‐stage kidney failure requiring kidney transplantation in developed countries.
Rejection of the kidney allograft is the most feared complication after kidney transplantation from a patient perspective, but it is unclear if patients with diabetes have an increased risk of this complication.
In this study, in the context of contemporary immunosuppression, we show that people with diabetes have an elevated risk of cellular rejection after kidney transplantation, but that this does not translate into adverse short‐to‐medium term kidney allograft outcomes.
Our data allow targeted risk counselling for people with diabetes who are awaiting kidney transplantation.</description><subject>Adult</subject><subject>Age Factors</subject><subject>Cohort analysis</subject><subject>Cohort Studies</subject><subject>Combined Modality Therapy - adverse effects</subject><subject>Data processing</subject><subject>Death</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Diabetic Nephropathies - complications</subject><subject>Diabetic Nephropathies - immunology</subject><subject>Diabetic Nephropathies - surgery</subject><subject>Diabetic Nephropathies - therapy</subject><subject>Disease-Free Survival</subject><subject>End-stage renal disease</subject><subject>England - epidemiology</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Graft rejection</subject><subject>Graft Rejection - complications</subject><subject>Graft Rejection - epidemiology</subject><subject>Graft Rejection - immunology</subject><subject>Graft Rejection - prevention & control</subject><subject>Health risk assessment</subject><subject>Hospitals, Teaching</subject><subject>Humans</subject><subject>Immunosuppression</subject><subject>Immunosuppression - adverse effects</subject><subject>Kidney diseases</subject><subject>Kidney Failure, Chronic - complications</subject><subject>Kidney Failure, Chronic - immunology</subject><subject>Kidney Failure, Chronic - surgery</subject><subject>Kidney Failure, Chronic - therapy</subject><subject>Kidney transplantation</subject><subject>Kidney Transplantation - adverse effects</subject><subject>Kidney transplants</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Observational studies</subject><subject>Proportional Hazards Models</subject><subject>Renal failure</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Survival</subject><subject>Transplantation</subject><subject>Transplants & implants</subject><issn>0742-3071</issn><issn>1464-5491</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp10cFu1DAQBmALUdGlcOAFkCUucEjrie0k5laVUpCK4ADnaOJMwNtsvNgOsDeeAPGMPEmdbukBCUuWZfnTr7F-xp6AOIa8TvoNHYOUjbzHVqAqVWhl4D5biVqVhRQ1HLKHMa6FgNJI84Adlo0GIct6xX59CPTn52_64WJy02feO-woUeQucuTBxSs-oE0-8CFvN9lAGKnnARfkB25pHOcRAw-0JpucnzgOiQK_cv1EO54CTnE74pRweXzJceK-ixS-3dxx5NZ_8SHxmOZ-94gdDDhGenx7HrFPr88_nr0pLt9fvD07vSysAiMLlMpSqZWCztS97sDUCrTVRmsr6p6g6hqlSoUgCIC0kY2RJQlRV7KqpJRH7Pk-dxv815liajcuLl_BifwcW2iMUaIyZZPps3_o2s8hD56VgSVZKMjqxV7Z4GMMNLTb4DYYdi2IdimpzSW1NyVl-_Q2ce421N_Jv61kcLIH391Iu_8nta_ene8jrwEaT5y5</recordid><startdate>201708</startdate><enddate>201708</enddate><creator>Johal, S.</creator><creator>Jackson‐Spence, F.</creator><creator>Gillott, H.</creator><creator>Tahir, S.</creator><creator>Mytton, J.</creator><creator>Evison, F.</creator><creator>Stephenson, B.</creator><creator>Nath, J.</creator><creator>Sharif, A.</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>8FD</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>P64</scope><scope>RC3</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7586-9136</orcidid></search><sort><creationdate>201708</creationdate><title>Pre‐existing diabetes is a risk factor for increased rates of cellular rejection after kidney transplantation: an observational cohort study</title><author>Johal, S. ; Jackson‐Spence, F. ; Gillott, H. ; Tahir, S. ; Mytton, J. ; Evison, F. ; Stephenson, B. ; Nath, J. ; Sharif, A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4193-a34ce25441b97d5b197415c5955c07de16b84424a10e11e5938932e0076366333</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>Age Factors</topic><topic>Cohort analysis</topic><topic>Cohort Studies</topic><topic>Combined Modality Therapy - adverse effects</topic><topic>Data processing</topic><topic>Death</topic><topic>Diabetes</topic><topic>Diabetes mellitus</topic><topic>Diabetic Nephropathies - complications</topic><topic>Diabetic Nephropathies - immunology</topic><topic>Diabetic Nephropathies - surgery</topic><topic>Diabetic Nephropathies - therapy</topic><topic>Disease-Free Survival</topic><topic>End-stage renal disease</topic><topic>England - epidemiology</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Graft rejection</topic><topic>Graft Rejection - complications</topic><topic>Graft Rejection - epidemiology</topic><topic>Graft Rejection - immunology</topic><topic>Graft Rejection - prevention & control</topic><topic>Health risk assessment</topic><topic>Hospitals, Teaching</topic><topic>Humans</topic><topic>Immunosuppression</topic><topic>Immunosuppression - adverse effects</topic><topic>Kidney diseases</topic><topic>Kidney Failure, Chronic - complications</topic><topic>Kidney Failure, Chronic - immunology</topic><topic>Kidney Failure, Chronic - surgery</topic><topic>Kidney Failure, Chronic - therapy</topic><topic>Kidney transplantation</topic><topic>Kidney Transplantation - adverse effects</topic><topic>Kidney transplants</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Observational studies</topic><topic>Proportional Hazards Models</topic><topic>Renal failure</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Survival</topic><topic>Transplantation</topic><topic>Transplants & implants</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Johal, S.</creatorcontrib><creatorcontrib>Jackson‐Spence, F.</creatorcontrib><creatorcontrib>Gillott, H.</creatorcontrib><creatorcontrib>Tahir, S.</creatorcontrib><creatorcontrib>Mytton, J.</creatorcontrib><creatorcontrib>Evison, F.</creatorcontrib><creatorcontrib>Stephenson, B.</creatorcontrib><creatorcontrib>Nath, J.</creatorcontrib><creatorcontrib>Sharif, A.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Diabetic medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Johal, S.</au><au>Jackson‐Spence, F.</au><au>Gillott, H.</au><au>Tahir, S.</au><au>Mytton, J.</au><au>Evison, F.</au><au>Stephenson, B.</au><au>Nath, J.</au><au>Sharif, A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pre‐existing diabetes is a risk factor for increased rates of cellular rejection after kidney transplantation: an observational cohort study</atitle><jtitle>Diabetic medicine</jtitle><addtitle>Diabet Med</addtitle><date>2017-08</date><risdate>2017</risdate><volume>34</volume><issue>8</issue><spage>1067</spage><epage>1073</epage><pages>1067-1073</pages><issn>0742-3071</issn><eissn>1464-5491</eissn><abstract>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.
What's new?
Diabetes remains the leading underlying cause of end‐stage kidney failure requiring kidney transplantation in developed countries.
Rejection of the kidney allograft is the most feared complication after kidney transplantation from a patient perspective, but it is unclear if patients with diabetes have an increased risk of this complication.
In this study, in the context of contemporary immunosuppression, we show that people with diabetes have an elevated risk of cellular rejection after kidney transplantation, but that this does not translate into adverse short‐to‐medium term kidney allograft outcomes.
Our data allow targeted risk counselling for people with diabetes who are awaiting kidney transplantation.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>28510327</pmid><doi>10.1111/dme.13383</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-7586-9136</orcidid></addata></record> |
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| ispartof | Diabetic medicine, 2017-08, Vol.34 (8), p.1067-1073 |
| issn | 0742-3071 1464-5491 |
| language | eng |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Adult Age Factors Cohort analysis Cohort Studies Combined Modality Therapy - adverse effects Data processing Death Diabetes Diabetes mellitus Diabetic Nephropathies - complications Diabetic Nephropathies - immunology Diabetic Nephropathies - surgery Diabetic Nephropathies - therapy Disease-Free Survival End-stage renal disease England - epidemiology Female Follow-Up Studies Graft rejection Graft Rejection - complications Graft Rejection - epidemiology Graft Rejection - immunology Graft Rejection - prevention & control Health risk assessment Hospitals, Teaching Humans Immunosuppression Immunosuppression - adverse effects Kidney diseases Kidney Failure, Chronic - complications Kidney Failure, Chronic - immunology Kidney Failure, Chronic - surgery Kidney Failure, Chronic - therapy Kidney transplantation Kidney Transplantation - adverse effects Kidney transplants Male Middle Aged Observational studies Proportional Hazards Models Renal failure Retrospective Studies Risk Factors Survival Transplantation Transplants & implants |
| title | Pre‐existing diabetes is a risk factor for increased rates of cellular rejection after kidney transplantation: an observational cohort study |
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