Received November 2, 2007
Accepted on January 29, 2008

ORIGINAL ARTICLES

Impact of Acute Rejection and New-Onset Diabetes on Long-Term Transplant Graft and Patient Survival

Edward H. Cole ^*, Olwyn Johnston , Caren L. Rose , and John S. Gill ¹

*Division of Nephrology and Multiorgan Transplant Programme, Toronto General Hospital, University of Toronto, Toronto, Ontario, and Division of Nephrology, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada

¹ To whom correspondence should be addressed. E-mail: jgill{at}providencehealth.bc.ca.

	Abstract

Background and objectives: Development of new therapeutic strategies to improve long-term transplant outcomes requires improved understanding of the mechanisms by which these complications limit long-term transplant survival.

Design, setting, participants, & measurements: The association of acute rejection and new-onset diabetes was determined in the first posttransplantation year with the outcomes of transplant failure from any cause, death-censored graft loss, and death with a functioning graft in 27,707 adult recipients of first kidney-only transplants, with graft survival of at least 1 yr, performed between 1995 and 2002 in the United States.

Results: In multivariate analyses, patients who developed acute rejection or new-onset diabetes had a similar risk for transplant failure from any cause, but the mechanisms of transplant failure were different: Acute rejection was associated with death-censored graft loss but only weakly associated with death with a functioning graft. In contrast new-onset diabetes was not associated with death-censored graft loss but was associated with an increased risk for death with a functioning graft.

Conclusions: Acute rejection and new-onset diabetes have a similar impact on long-term transplant survival but lead to transplant failure through different mechanisms. The mechanisms by which new-onset diabetes leads to transplant failure should be prospectively studied. Targeted therapeutic strategies to minimize the impact of various early posttransplantation complications may lead to improved long-term outcomes.