Introduction: Insulin resistance is prevalent disorder, but its clinical significance remains undermined. We explored the clinical implication of triglyceride-glucose (TyG) index in renal transplant recipients, recognizing it as a valuable marker for insulin resistance.
Methods: A total of 6,354 renal transplant recipients were enrolled from a nationwide, prospective cohort between May 2014 and December 2022. The TyG index was assessed between 6- and 12-months post-transplantation. We evaluated the association between TyG index and the risk of composite of cardiovascular events and death, and the renal allograft loss.
Results: During the mean follow-up period of 39.2 ± 26.1 months, a total of 106 composite events of cardiovascular events and death, and 174 events of renal allograft loss were observed. The cumulative rate for both composite events and graft loss was higher in patients with higher TyG quartile (all P < 0.05). In multivariate analysis, a higher quartile of TyG was linked to a greater risk of composite events, and one-unit increase in the TyG index was associated with increased risk of composite events (HR 1.38, 95% CI 1.10 – 1.91). The risk of renal allograft loss increased in higher TyG quartiles, with the risk escalating with each unit increase in TyG (HR 1.52, 95% CI 1.18 – 1.96). The most predictive cutoff of TyG was 8.6 for composite events and 8.9 for graft loss. Patients with TyG index ≥8.9 showed more rapid decline in eGFR of -3.14 (95% CI -4.62 to -1.66) compared to those with TyG index <8.9.
Conclusion: Renal transplant recipients with higher TyG index are associated with higher risk of composite of cardiovascular event and death, renal allograft loss, and more rapid decline of graft function.