Impact of New-Onset Diabetes after Transplantation on Cardiovascular Risk and Mortality in Korea: A Nationwide Population-Based Study.

IF 6.8 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Diabetes & Metabolism Journal Pub Date : 2024-09-12 DOI:10.4093/dmj.2024.0078
Seung Shin Park,Bo Kyung Koo,Sanghyun Park,Kyungdo Han,Min Kyong Moon
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Abstract

Background Limited data are available on the adverse effects of new-onset diabetes after transplantation (NODAT) in solid organ transplantation (TPL) other than kidney. This study aimed to identify the risk of complications associated with NODAT in recipients of kidney, liver, or heart TPL. Methods Using the Korean National Health Insurance Service database, recipients of kidney, liver, or heart TPL between 2009 and 2015 were identified. The incidence of coronary artery disease (CAD), cerebrovascular accident (CVA), and malignancy was compared across groups with NODAT, pretransplant diabetes mellitus (DM), and without DM using Cox regression analysis. Results A total of 9,632 kidney, liver, or heart TPL recipients were included. During the median follow-up of 5.9 years, NODAT independently increased the incidence of CAD (hazard ratio [HR], 2.46; 95% confidence interval [CI], 1.39 to 4.30) and overall mortality (HR, 1.48; 95% CI, 1.14 to 1.95) compared to the reference group even after adjustment for confounders; this was more prominent in kidney TPL than in liver TPL. The risk of CVA was significantly increased by pretransplant DM but not by NODAT in both kidney and liver TPL (HR, 2.47; 95% CI, 1.68 to 3.65; and HR, 3.18; 95% CI, 1.07 to 9.48, respectively). NODAT increased the risk of malignancy in the crude model, which lost its statistical significance after confounder adjustment. Conclusion NODAT independently increases the risk of CAD and mortality after TPL, which is more evident in kidney recipients. There was no additional increased risk of CVA or malignancy with NODAT in solid organ TPL.
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韩国移植后新发糖尿病对心血管风险和死亡率的影响:一项基于全国人口的研究。
背景有关肾脏以外的实体器官移植(TPL)后新发糖尿病(NODAT)不良影响的数据有限。本研究旨在确定肾脏、肝脏或心脏移植受者出现 NODAT 相关并发症的风险。方法利用韩国国民健康保险服务数据库,确定 2009 年至 2015 年间肾脏、肝脏或心脏移植的受者。结果共纳入9632名肾脏、肝脏或心脏TPL受者。在中位随访 5.9 年期间,与参照组相比,即使调整了混杂因素,NODAT 也会独立增加 CAD 的发病率(危险比 [HR],2.46;95% 置信区间 [CI],1.39 至 4.30)和总死亡率(HR,1.48;95% 置信区间 [CI],1.14 至 1.95);肾脏 TPL 比肝脏 TPL 的这一情况更为突出。在肾脏和肝脏 TPL 中,移植前 DM 会显著增加 CVA 的风险,但 NODAT 不会(HR,2.47;95% CI,1.68-3.65;HR,3.18;95% CI,1.07-9.48)。在粗略模型中,NODAT会增加恶性肿瘤的风险,但在对混杂因素进行调整后,该风险失去了统计学意义。在实体器官TPL中,NODAT不会增加CVA或恶性肿瘤的风险。
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来源期刊
Diabetes & Metabolism Journal
Diabetes & Metabolism Journal Medicine-Endocrinology, Diabetes and Metabolism
CiteScore
10.40
自引率
6.80%
发文量
92
审稿时长
52 weeks
期刊介绍: The aims of the Diabetes & Metabolism Journal are to contribute to the cure of and education about diabetes mellitus, and the advancement of diabetology through the sharing of scientific information on the latest developments in diabetology among members of the Korean Diabetes Association and other international societies. The Journal publishes articles on basic and clinical studies, focusing on areas such as metabolism, epidemiology, pathogenesis, complications, and treatments relevant to diabetes mellitus. It also publishes articles covering obesity and cardiovascular disease. Articles on translational research and timely issues including ubiquitous care or new technology in the management of diabetes and metabolic disorders are welcome. In addition, genome research, meta-analysis, and randomized controlled studies are welcome for publication. The editorial board invites articles from international research or clinical study groups. Publication is determined by the editors and peer reviewers, who are experts in their specific fields of diabetology.
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