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


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.

SUBMITTER: Chanchlani R 

PROVIDER: S-EPMC6399486 | biostudies-literature | 2019 Mar

REPOSITORIES: biostudies-literature

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Publications

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

Chanchlani Rahul R   Kim Sang Joseph SJ   Dixon Stephanie N SN   Jassal Vanita V   Banh Tonny T   Borges Karlota K   Vasilevska-Ristovska Jovanka J   Paterson John Michael JM   Ng Vicky V   Dipchand Anne A   Solomon Melinda M   Hebert Diane D   Parekh Rulan S RS  

Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association 20190301 3


<h4>Background</h4>Precise estimates of the long-term risk of new-onset diabetes and its impact on mortality among transplanted children are not known.<h4>Methods</h4>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-transpl  ...[more]

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