The aim of this study was to compare management strategy and clinical outcomes for kidney transplant recipients with pre-transplant versus post-transplantation diabetes (PTDM) in a contemporary cohort.
This is a single-centre, retrospective. observational study of kidney transplant recipients between 2007-2018 with follow up to 31 December 2020. Data was extracted from hospital electronic patient records, with clinical outcomes linked to national datasets. PTDM was diagnosed by international consensus guidelines. Unadjusted and adjusted survival outcomes were assessed with Kaplan-Meier curves and Cox regression models respectively, with PTDM handled as a time-varying covariate.
Data was analysed for 1,757 kidney transplant recipients, of whom 11.8% (n=207) had pre-transplant diabetes and 13.8% (n=243) developed PTDM with median time to onset 108 days (IQR 46-549 days). Median follow up was 1,839 days (interquartile range 928-2985 days). Disparate management strategies were observed, although insulin was the commonest glucose-lowering therapy for all patients with diabetes. In adjusted models, PTDM was associated with lower mortality (HR 0.663, 95% CI 0.543-0.810) and pre-diabetes with higher mortality (HR 1.675, 95% CI 1.396-2.011). However, if analyses are restricted to those with at least 5-year follow up, then PTDM has no association with mortality (HR 0.771, 95% CI 0.419-1.096) but pre-transplant diabetes remains associated with higher mortality (HR 2.029, 95% CI 1.367-3.012).
Pre-transplant diabetes remains associated with increased mortality risk after kidney transplantation but PTDM effects are time dependent. Development of PTDM should be encouraged as a mandated registry return to study long-term impact on survival outcomes.

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