肾移植受者移植后糖尿病,单中心数据:发病率,危险因素,以及对移植物功能和死亡率的影响

Dileep Kumar, Kashif Gulzar, F. Alalawi, A. Seddik, Hind Alnour, Maseer Ahmed, S. Najad, Hussein Yousif, Mohamed Hussain Railey, A. Alhadari
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摘要

背景:移植后新生糖尿病(PTDM)是肾移植受者常见的并发症;它具有移植物衰竭和患者死亡的高风险。这项单中心研究旨在确定PTDM的发生率和危险因素及其对移植物预后和死亡率的影响。方法:对383例非糖尿病肾移植受者进行单中心纵向队列分析,通过详细的图表回顾分析结果。我们假设不同的供体和受体特征,如年龄、性别和HLA不匹配会影响肾移植受者PTDM的发展。PTDM的定义基于空腹血糖(≥7 mmol/L或≥126 mg/dL)、随机血糖(≥11.1 mmol/L或≥200 mg/dL)和糖化血红蛋白(HBA1C >6.5%或48 mmol/mol)。我们使用Cox回归评估PTDM的发病率、危险因素及其对患者死亡率和移植物结局的影响。结果:移植时平均年龄为35.70(±14.27)岁,男性占50.91%。研究期间PTDM的发生率为23.30%。独立危险因素包括移植时年龄较大、环孢素免疫抑制、巨细胞病毒和丙型肝炎病毒感染。PTDM与移植物功能障碍无关,但其死亡率明显较高。结论:PTDM在肾移植受者中较为常见。移植时年龄较大、环孢素免疫抑制、巨细胞病毒和丙型肝炎病毒是危险因素。PTDM死亡率高,但与移植物衰竭无关。
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Post-Transplant Diabetes Mellitus in Renal Transplant Recipients, Single-Centre Data: Incidence, Risk Factors, and Effect on Graft Function and Mortality
Background: De novo post-transplant diabetes mellitus (PTDM) is a frequent complication among renal transplant recipients; it confers a high risk for graft failure and patient mortality. This single-centre study aimed to determine the incidence and risk factors of PTDM and its effects on graft outcome and mortality. Methods: In a single-centre longitudinal cohort analysis of 383 non-diabetic renal transplant follow-up recipients, outcomes were analysed through a detailed chart review. We hypothesized that different donor and recipient characters such as age, gender, and HLA mismatch would affect PTDM development in renal transplant recipients. PTDM is defined on basis of fasting plasma sugar (≥7 mmol/L or ≥126 mg/dL), random plasma sugar (≥11.1 mmol/L or ≥200 mg/dL), and glycated haemoglobin (HBA1C: >6.5% or 48 mmol/mol). We assessed PTDM incidence, risk factors, and its effect on patient mortality and graft outcome using Cox regression. Results: The mean age at the time of transplantation was 35.70 (±14.27) years, and 50.91% were male. PTDM incidence in the study period was 23.30%. Independent risk factors include older age at the time of transplantation, cyclosporine immunosuppression, cytomegalovirus, and hepatitis C virus infection. PTDM is not associated with graft dysfunction, whereas it significantly carries high mortality. Conclusion: PTDM is common among renal transplant recipients. Older age at the time of transplantation, cyclosporine immunosuppression, cytomegalovirus, and hepatitis C virus are risk factors. PTDM carries high mortality but is not associated with graft failure.
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