The influence of recipient's pre-existing diabetes mellitus on outcomes of living donor kidney transplant.
To determine the influence of recipients' pre-existing diabetes mellitus on the outcomes of living donor kidney transplantation.
This prospective observational cohort study included 202 patients who underwent kidney transplantation between September 2022 and December 2023 at Dow University Hospital, Pakistan, and were stratified into two equal groups: pre-existing diabetes and non-diabetes. Patients with new-onset diabetes after transplantation were excluded. Demographic and clinical data were collected. Outcomes, including one-year patient survival and post-transplant complications, were assessed and compared.
Complications were high in the pre-existing diabetes group (57.4% vs. 28.7%, p <0.001). Infections occurred in 46.5% of patients with pre-existing diabetes versus 22.8% non-DM (p <0.001). Post-transplant cardiovascular events were observed in 6.9% of patients in the pre-existing DM group, whereas none were observed in the non-DM group (p = 0.014). One-year patient survival was 88.1% in the pre-existing DM group versus 95% in the non-DM group (p = 0.075). Graft-related complications did not differ significantly between the groups. Multivariate analysis identified pre-transplant congestive heart failure (HR = 99.431, [95% CI 7.709-128.441, p <0.001]), pre-transplant peripheral vascular disease (HR =7.787, [95% CI 1.197-50.682, p = 0.032]), post-transplant cardiovascular events (HR = 7.839, [95% CI 1.423-43.198, p = 0.018]), and post-transplant FBS (HR = 1.023, [95% CI 1.001-1.046, p = 0.040]) as independent predictors of mortality.
Diabetes did not influence one-year patient survival and graft-specific outcomes but led to frequent post-transplant complications. Pre- and post-transplant cardiovascular disease and elevated post-transplant FBS levels were associated with mortality. Therefore, structured pre-transplant cardiovascular assessment and optimization, ongoing post-transplant cardiovascular surveillance, and strict glycemic control are required.
This prospective observational cohort study included 202 patients who underwent kidney transplantation between September 2022 and December 2023 at Dow University Hospital, Pakistan, and were stratified into two equal groups: pre-existing diabetes and non-diabetes. Patients with new-onset diabetes after transplantation were excluded. Demographic and clinical data were collected. Outcomes, including one-year patient survival and post-transplant complications, were assessed and compared.
Complications were high in the pre-existing diabetes group (57.4% vs. 28.7%, p <0.001). Infections occurred in 46.5% of patients with pre-existing diabetes versus 22.8% non-DM (p <0.001). Post-transplant cardiovascular events were observed in 6.9% of patients in the pre-existing DM group, whereas none were observed in the non-DM group (p = 0.014). One-year patient survival was 88.1% in the pre-existing DM group versus 95% in the non-DM group (p = 0.075). Graft-related complications did not differ significantly between the groups. Multivariate analysis identified pre-transplant congestive heart failure (HR = 99.431, [95% CI 7.709-128.441, p <0.001]), pre-transplant peripheral vascular disease (HR =7.787, [95% CI 1.197-50.682, p = 0.032]), post-transplant cardiovascular events (HR = 7.839, [95% CI 1.423-43.198, p = 0.018]), and post-transplant FBS (HR = 1.023, [95% CI 1.001-1.046, p = 0.040]) as independent predictors of mortality.
Diabetes did not influence one-year patient survival and graft-specific outcomes but led to frequent post-transplant complications. Pre- and post-transplant cardiovascular disease and elevated post-transplant FBS levels were associated with mortality. Therefore, structured pre-transplant cardiovascular assessment and optimization, ongoing post-transplant cardiovascular surveillance, and strict glycemic control are required.