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Kidney Week

Abstract: PO2072

The Impact of New-Onset Diabetes After Transplantation on Survival and Major Cardiovascular Events in Korean Kidney Transplantation Recipients

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Lee, Jangwook, Dongguk University Medical Center, Goyang, Gyeonggi, Korea (the Republic of)
  • Kang, Donghyun, Chung-Ang University, Seoul, Seoul, Korea (the Republic of)
  • Park, Sehoon, Armed Forces Capital Hospital, Seongnam, Gyeonggi-do, Korea (the Republic of)
  • Kim, Ji Eun, Korea University Guro Hospital, Seoul, Korea (the Republic of)
  • Kang, Eunjeong, Ewha womans University Seoul Hospital, Seoul, Korea (the Republic of)
  • Kim, Yaerim, Keimyung University Dongsan Medical Center, Daegu, Korea (the Republic of)
  • Kim, Yong Chul, Seoul National University Hospital Department of Internal Medicine, Jongno-gu, Seoul, Korea (the Republic of)
  • Kim, Yon Su, Seoul National University Hospital Department of Internal Medicine, Jongno-gu, Seoul, Korea (the Republic of)
  • Lim, Yaeji, Chung-Ang University, Seoul, Seoul, Korea (the Republic of)
  • Lee, Hajeong, Seoul National University Hospital Department of Internal Medicine, Jongno-gu, Seoul, Korea (the Republic of)
Background

New-onset diabetes after transplantation (NODAT) is a frequent complication in kidney transplant (KT) recipients with unfavorable outcomes, although a nationwide study on epidemiology and clinical outcome of NODAT in Korean KT recipients remain rare.

Methods

We identified KT recipients by using a Health Insurance Review and Assessment Service of South Korea from the year of 2008 to 2017. We excluded patients with preexisting diabetes, multi-organ transplantation, and being progressed to graft failure less than 1 year after KT. NODAT was defined as consecutive 30 days prescription history of antidiabetic medication after KT. We analyzed the impact of NODAT on death censored graft failure (DCGF), death without graft failure (DWGF), and major adverse cardiovascular events (MACE) by time-dependent Cox analysis.

Results

Among a total of 16,719 KT recipients, 10,311 were included after exclusion. 19.8 percent of KT recipients were diagnosed to NODAT. The proportion of patients developing NODAT tended to increase, and 64% of NODAT was diagnosed within the first 6-months after KT. NODAT patients were older, more men, having longer pre-KT dialysis vintages, and being exposed more basiliximab induction and more rejection episodes requiring high-dose steroids treatment after KT. During follow-up, 520 DCGF, 180 DWGF, and 213 MACE events were occurred. NODAT patients showed higher risks of DCGF (adjusted hazard ratio [aHR], 1.87; 95% confidence interval [CI], 1.52-2.3; p < 0.001), DWGF (aHR 1.77;95% CI, 1.28-2.43;p<0.001), and MACE (aHR 1.46;95% CI, 1.08-1.96;p=0.013) than patients without NODAT. Twenty-one percent of NODAT patients could be stopped their anti-diabetic medications after the diagnosis, although this did not affect the clinical outcomes.

Conclusion

About 20% of diabetes-naïve KT recipients were diagnosed with NODAT with a recently increasing pattern. NODAT in KT recipients affected worse graft and patients outcomes as well as MACE.

Funding

  • Government Support – Non-U.S.