Effects of acute rejection vs new‐onset diabetes after transplant on transplant outcomes in pediatric kidney recipients: analysis of the Organ Procurement and Transplant Network/United Network for Organ Sharing (OPTN/UNOS) database |
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| Authors: | Alireza Mehrnia Thuy X. Le Tamer R. Tamer Suphamai Bunnapradist |
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| Affiliation: | Kidney Transplant Program, University of California, CA, USA |
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| Abstract: | ![]()
Improving long‐term transplant and patient survival is still an ongoing challenge in kidney transplant medicine. Our objective was to identify the subsequent risks of new‐onset diabetes after transplant (NODAT) and acute rejection (AR) in the first year post‐transplant in predicting mortality and transplant failure. A total of 4687 patients without preexisting diabetes (age 2–20 years, 2004–2010) surviving with a functioning transplant for longer than 1 year with at least one follow‐up report were identified from the OPTN/UNOS database as of September 2014. Study population was stratified into four mutually exclusive groups: Group 1, patients with a history of AR; Group 2, NODAT+; Group 3, NODAT+ AR+; and Group 4, the reference group (neither). Multivariate regression was used to analyze the relative risks for the outcomes of transplant failure and mortality. The median follow‐up time was 1827 days after 1 year post‐transplant. AR was associated with an increased risk of adjusted graft and death‐censored graft failure (HR 2.87, CI 2.48–3.33, P < .001 and HR 2.11, CI 1.81–2.47, P < .001), respectively. NODAT and AR were identified in 3.5% and 14.5% of all study patients, respectively. AR in the first year post‐transplant was a major risk factor for overall and death‐censored graft failure, but not mortality. However, NODAT was not a risk factor on graft survival or mortality. |
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| Keywords: | acute rejection pediatric kidney transplant new onset diabetes after transplant pediatric transplantation rejection |
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