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Abstract: FR-PO818

Transition of Metabolic Dysfunction After Kidney Transplantation and Its Association With Transplant Outcomes: A Nationwide Prospective Cohort Study

Session Information

Category: Transplantation

  • 2002 Transplantation: Clinical

Authors

  • Lee, Yu ho, CHA Bundang Medical Center, Seongnam, Gyeonggi-do, Korea (the Republic of)
  • Lee, So-young, CHA Bundang Medical Center, Seongnam, Gyeonggi-do, Korea (the Republic of)
  • Kim, Jin sug, Kyung Hee University Medical Center, Dongdaemun-gu, Seoul, Korea (the Republic of)
  • Jeong, Kyung hwan, Kyung Hee University Medical Center, Dongdaemun-gu, Seoul, Korea (the Republic of)
  • Hwang, Hyeon Seok, Kyung Hee University Medical Center, Dongdaemun-gu, Seoul, Korea (the Republic of)
Background

Metabolic dysfunction (MD) is prevalent disorder in patients with end-stage kidney disease and kidney transplantation is expected to modify the metabolic status. However, it remains unclear whether the transition of metabolic status before and after transplantation affects the transplant outcomes.

Methods

We analyzed 4187 kidney transplant recipients registered in a nationwide prospective cohort from 2014 to 2020. MD was considered, if ≥3 conditions are met (body mass index, blood pressure, fasting blood glucose, triglyceride, and high-density lipoprotein cholesterol level). Patients were categorized into four groups based on the presence of MD at pre-transplant and one-year post-transplant. The primary outcome was the occurrence of death-censored graft failure and patient death.

Results

Prevalence of pre- and post-transplant MD was 49.0% and 40.1%, respectively. Among recipients without pre-transplant MD, 19.6% (419/2135) developed MD at one-year post-transplantation. By contrast, MD disappeared in 38.7% (794/2052) of the recipients with pre-transplant MD. The cumulative event rate of composite of graft failure and patient death was significantly higher in both recipients with newly developed post-transplant MD and recipients with persistent MD (p < 0.001). Compared to recipients without pre- and post-transplant MD, those with newly developed post-transplant MD showed an increased risk of graft failure (adjusted hazard ratio [HR] 2.41, 95% confidence interval [CI] 1.17-4.98) and those with persistent MD had higher risk of patient death (adjusted HR = 2.51, 95% CI 1.12-5.63). The risk of composite event was increased as more metabolic components was converted to be dysfunctional after transplantation. An analysis of each component of MD showed that a normalization of blood pressure after transplantation led to a decrease in the risk of composite event.

Conclusion

Kidney transplantation significantly affects the metabolic status in patients with end-stage kidney disease. Newly developed post-transplant MD increases the risk of graft loss and persistent post-transplant MD adversely affects patient survival, suggesting that transition of metabolic status was significantly associated with kidney transplant outcomes.

Funding

  • Government Support – Non-U.S.