The impact of early-diagnosed new-onset post-transplantation diabetes mellitus on survival and major cardiac events

The impact of early-diagnosed new-onset post-transplantation diabetes mellitus (PTDM) on cardiovascular (CV) disease is not well described. The objectives of the present prospective single-center observational study were to assess the long-term effects of early-diagnosed new-onset PTDM on major cardiac events (MCE; cardiac death or nonfatal acute myocardial infarction) and patient survival. Diabetic status and CV risk factors were assessed in 201 consecutive renal allograft recipients 3 months after transplantation (baseline) during a period of 16 months (1995-96). Follow-up data until January 1, 2004 were obtained from the Norwegian Renal Registry. The 8-year (range 7-9 years) cumulative incidence of MCEs was 7% (nine out of 138) in recipients without diabetes, 20% (seven out of 35) in patients with new-onset PTDM and 21% (six out of 28) in patients with diabetes mellitus before transplantation (DM). Proportional hazards regression analyses (forward stepwise regression) revealed that patients with PTDM had an approximately three-fold increased risk of MCEs as compared with nondiabetic patients (hazard ratio (HR) = 3.27, 95% confidence interval (Cl) = 1.22-8.80, P = 0.019). A total of 61 patients (30%) died. Eight-year patient survival was 80% in the nondiabetic group, 63% in the PTDM group and 29% in the DM group, respectively. Pretransplant diabetes (HR = 5.09, 95% Cl = 2.60-9.96, P < 0.001), age (HR = 1.03, 95% Cl = 1.01-1.05, P = 0.016), cytomegalovirus (CMV) infection (HR = 2.66, 95% Cl = 1.27-5.53, P = 0.009), and creatinine clearance (HR = 0.98, 95% Cl = 0.96-1.00, P = 0.046), but not PTDM (HR = 1.20, 95% Cl = 0.58-2.49, P = 0.621), were independent predictors of death in the multiple Cox regression model. Early-diagnosed PTDM is a predictor of MCEs, but not of all-cause mortality, the first 8 years after renal transplantation.