Effect of Post-transplant Glycemic Control on Long-term Clinical Outcomes in Kidney Transplant Recipients

Abstract

Introduction Diabetic nephropathy is the leading cause of end stage renal disease (ESRD). The number of kidney transplantations due to diabetic nephropathy is increasing and there is debate on glycemic control after kidney transplantation. In this study, I used a multi-center database to determine the relationship between post-transplant glycemic control and the outcomes of kidney transplantation in patients with diabetic nephropathy. Methods: I conducted a retrospective chart review of kidney transplant recipients(KTRs) with diabetic nephropathy from three tertiary hospitals to analyze the association between post-transplant glycemic control and the clinical outcomes of graft failure, including patient death and biopsy-proven acute rejection (BPAR). Among 3,538 KTRs, a total of 476 patients received kidney transplantation because of diabetic nephropathy. I assessed time-averaged glucose level and hemoglobin A1c (HbA1c) for 36 months after kidney transplantation. Results: Mean time-averaged glucose and HbA1c levels were 147 ± 46 mg/dl and 7.7 ± 1.5 %, respectively. The highest quartile of baseline glucose was related to poor graft outcomes and the 3rd quartile of time-averaged HbA1c was associated with significantly better graft outcomes than the 1st, 2nd or 4th quartiles. On the other hand, time averaged glucose levels were not significantly related to graft outcomes. There were no significant differences in the risk of BPAR across the 4 quartiles of glucose and HbA1c. Conclusions: Strict glycemic control post-transplantation is not necessary for successful outcomes but poor glycemic control is associated with poor graft outcomes. There was no significant relationship between post-transplant glycemic control and BPAR.