Diabetes mellitus (DM) and cardiovascular disease (CVD) are major public health challenges and also leading causes of post-transplant mortality following renal transplantation. In transplant patients, pre-transplant diabetes as well as newly developed diabetes after transplantation is associated with poor post-transplant outcomes. In this study, we aimed to investigate the effect of pre-transplant diabetes (Pre-DM) and post-transplant diabetes (PTDM) on cardiovascular events in kidney transplant recipients. We analyzed 1930 patients who underwent kidney transplantation at tertiary care hospital between 1979 and 2020. Subjects were classified into the 3 groups (Pre-DM, PTDM, Non-DM) according to whether diabetes was diagnosed and the date of diagnosis was before or after surgery. A Cox proportional hazard model was used to investigate the association between the type of DM (vs. Non-DM) and the incidence of four-point major adverse cardiovascular events (4P-MACE) . During the study follow-up period (median 6.5 years) , 4P-MACE occurred in 36 (3.1%) patients with Non-DM, 65 patients (14.3%) with Pre-DM and 33 (10.7%) patients with PTDM. Pre-DM was significantly associated with increasing risk of cardiovascular events after adjustment for confounding factors including age, sex, BMI, waiting time, ABO incompatibility, number of HLA mismatch, previous cardiovascular disease, donor age and donor type (living or deceased) (hazard ratio (HR) 3.62, 95% confidence interval (CI) 2.29-5.74, p<0.001) . In the Kaplan-Meier curve of the cumulative incidence of 4P-MACE, subjects with Pre-DM had the highest risk of cardiovascular events and those with PTDM had intermediate risk of events. The presence of both Pre-DM or PTDM significantly increased the risk of cardiovascular events in kidney transplant recipients. This suggests the need for management to minimize the long-term impact of pre-existing DM and PTDM in transplant patients.

Disclosure

S.Lee: None. S.Hong: None. M.Lee: None. Y.Kim: None. H.Kim: None. H.Lee: None. J.Lee: None. E.Kang: None.

Funding

Severance Hospital Research fund for Clinical excellence (SHRC) (C-2021-0007)

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at http://www.diabetesjournals.org/content/license.