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Kidney Week

Abstract: PO2136

Clinical Significance of Vitamin D on Preexisting and Post-Transplant Diabetes Mellitus in Kidney Transplantation: Korean Cohort Study for Outcome in Patients with Kidney Transplantation (KNOW-KT)

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Park, Woo Yeong, Keimyung University School of Medicine, Daegu, Korea (the Republic of)
  • Kim, Yaerim, Keimyung University School of Medicine, Daegu, Korea (the Republic of)
  • Paek, Jin hyuk, Keimyung University School of Medicine, Daegu, Korea (the Republic of)
  • Jin, Kyubok, Keimyung University School of Medicine, Daegu, Korea (the Republic of)
  • Han, Seungyeup, Keimyung University School of Medicine, Daegu, Korea (the Republic of)
Background

Kidney transplant recipients (KTRs) with preexisting DM or post-transplant diabetes mellitus (PTDM) have poor clinical outcomes. An association between vitamin D and diabetes mellitus (DM) has been reported, but there are few reports for impact of vitamin D on preexisting DM and PTDM.

Methods

A total of 995 KTRs were enrolled in KoreaN cohort study for Outcome in patients With Kidney Transplantation (KNOW-KT) between July 2012 and August 2016. KTRs were categorized into 3 groups: nondiabetic, preexisting DM and PTDM. Vitamin D status at KT was defined to deficiency (<10 ng/ml), insufficiency (10-30 ng/ml), and normal (≥30 ng/ml). This study aims to investigate clinical significance of vitamin D based on diabetic status in KTRs.

Results

Nondiabetic group was 643 (64.6%), preexisting DM group, 267 (26.8%), and PTDM group, 85 (8.5%). In all groups, vitamin D levels gradually increased after KT, then showed equilibrium at 2 years, and decreased after 4 years, but there was no significant difference of vitamin D levels. The proportion of vitamin D deficiency at KT was the highest in preexisting DM group compared with other groups, but there was no significant difference of that since 1 year after KT. There were no significant differences of immunologic findings among them. The rate of cardiovascular event was significantly higher in preexisting DM group compared with other groups (P<0.001). Death-censored graft survival rate was significantly lower in preexisting DM group compared with other groups (P=0.049), but there was no significant difference according to vitamin D status. Death-censored graft survival rate in KTRs with preexisting DM and vitamin D deficiency was the lowest, and it showed the significant synergistic effect on the allograft outcome (P=0.022). In the multivariate analysis, older age was an independent risk factors for allograft failure (HR 1.045, 95% C.I. 1.005-1.087, P=0.026). Patient survival rate was significantly lower in preexisting DM group compared with other groups (P=0.008).

Conclusion

The prognosis of KTRs with preexisting DM and vitamin D deficiency was the worst comparing nondiabetic and PTDM groups. Therefore, careful monitoring after KT of candidates with pre-transplant DM and vitamin D deficiency is required.