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Nephrol Dial Transplant. 2019 Mar 1;34(3):524-531. doi: 10.1093/ndt/gfy213.

Incidence of new-onset diabetes mellitus and association with mortality in childhood solid organ transplant recipients: a population-based study.

Chanchlani R1,2,3,4, Kim SJ3,5,6, Dixon SN6,7, Jassal V5, Banh T2, Borges K2, Vasilevska-Ristovska J2, Paterson JM3,6, Ng V8,9,10, Dipchand A9,10,11, Solomon M9,10,12, Hebert D1,9,10, Parekh RS1,2,3,5,9,10,13.

Author information

1
Department of Pediatrics, Division of Pediatric Nephrology, Hospital for Sick Children, Toronto, ON, Canada.
2
Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, ON, Canada.
3
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
4
Department of Pediatrics, Division of Nephrology, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada.
5
Department of Medicine, Division of Nephrology, University Health Network, Toronto, ON, Canada.
6
Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
7
Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.
8
Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, ON, Canada.
9
Department of Pediatrics, University of Toronto, Toronto, ON, Canada.
10
Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada.
11
Department of Pediatrics, Labatt Family Heart Centre, Hospital for Sick Children, Toronto, ON, Canada.
12
Department of Pediatrics, Division of Pediatric Respiratory Medicine, Hospital for Sick Children, Toronto, ON, Canada.
13
Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.

Abstract

BACKGROUND:

Precise estimates of the long-term risk of new-onset diabetes and its impact on mortality among transplanted children are not known.

METHODS:

We conducted a cohort study comparing children undergoing solid organ (kidney, heart, liver, lung and multiple organ) transplant (n = 1020) between 1991 and 2014 with healthy non-transplanted children (n = 7 134 067) using Ontario health administrative data. Outcomes included incidence of diabetes among transplanted and non-transplanted children, the relative hazard of diabetes among solid organ transplant recipients, overall and at specific intervals posttransplant, and mortality among diabetic transplant recipients.

RESULTS:

During 56 019 824 person-years of follow-up, the incidence rate of diabetes was 17.8 [95% confidence interval (CI) 15-21] and 2.5 (95% CI 2.5-2.5) per 1000 person-years among transplanted and non-transplanted children, respectively. The transplant cohort had a 9-fold [hazard ratio (HR) 8.9; 95% CI 7.5-10.5] higher hazard of diabetes compared with those not transplanted. Risk was highest within the first year after transplant (HR 20.7; 95% CI 15.9-27.1), and remained elevated even at 5 and 10 years of follow-up. Lung and multiple organ recipients had a 5-fold (HR 5.4; 95% CI 3.0-9.8) higher hazard of developing diabetes compared with kidney transplant recipients. Transplant recipients with diabetes had a three times higher hazard of death compared with those who did not develop diabetes (HR 3.3; 95% CI 2.3-4.8).

CONCLUSIONS:

The elevated risk of diabetes in transplant recipients persists even after a decade, highlighting the importance of ongoing surveillance. Diabetes after transplantation increases the risk of mortality among childhood transplant recipients.

KEYWORDS:

administrative databases; cohort study; death; incidence; outcomes

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