Impact of type 2 diabetes and obesity on contemporary adult living donor kidney transplant outcomes – a national cohort study
Vinayak Rohan1, Alex Tran 1, Erin Kinsella 1, Mike Casey 2, Dave Taber2.
1Surgery , Northwestern Memorial Hospital < northwestern University , Chicago, IL, United States; 2Surgery , Medical University of South Carolina , Charleston , SC, United States
Introduction: Type 2 Diabetes Mellitus (T2DM) is the most common cause of end-stage renal disease (ESRD) and is the most common indication for kidney transplantation (upwards of 30-40%) in United States . Living donor kidney transplant (LDKT) is the treatment of choice for ESRD. The interaction between T2DM and obesity on long-term outcomes in LDKT has yet to be studied.
Aim: To study the longterm interaction of obesity and T2DM on LDKT outcomes.
Methods: The Scientific Registry of Transplant Recipients(SRTR) database was queried for adult KT recipients with and without T2DM at time of transplant from 2002 to 2018 with follow-up to Dec 2021. Pediatric and multiorgan transplants were excluded. Primary outcomes were graft loss and patient survival using a multivariate Cox regression adjusting for age, gender, race, dialysis before transplant, and transplant-related and immunological factors.
Results: We analyzed 74,438 patients who underwent LDKT. These patients were stratified by T2DM status at time of transplant and BMI class. In non-diabetic LDKT patients, the risk of death-censored graft loss increased incrementally with body mass Index (BMI); BMI >40 had an increased risk of graft loss compared to BMI 18.5-25 (HR 1.2, 95% CI 1.1-1.29, p< 0.0001). Whereas T2DM was associated with an increased risk of death-censored graft loss irrespective of BMI. Overall risk of death in non-diabetic LDKT patients also increased increased incrementally with obesity whereas overall risk of death in patients with T2DM was greatly increased, irrespective of BMI. Risk of death in T2DM LDKT patients with BMI 30-34.9 was 160% (HR 2.6, 95%CI 2.4-2.8, p<0.0001) higher than that of the non-diabetic group.
Conclusions: In this contemporary cohort of LDKT, in non T2DM recipients, incremental increase in obesity was associated with incremental increased risk of graft loss and death. However, T2DM recipients graft loss and death were increased irrespective of BMI . Further studies are necessary to understand the specific risk factors conferred by T2DM and elucidate the value of pre- and post-transplant interventions.
