ADMISSION PRE-TRANSPLANT HBA1C AND THE RISK OF DIABETES AND ADVERSE OUTCOMES POST-KIDNEY TRANSPLANTATION
Su Jen Chua1, John Whitlam1,2, Sara Baqar3, Elif Ekinci4,5, Darren Lee1,6 1Kidney Transplant Service, Department of Nephrology, Austin Health, Heidelberg, Victoria, Australia2Victorian Clinical Genetics Services, Murdoch Children’s Research Institute, Parkville, VIC, Australia3Clinical Director Internal Medicine, Department of Medicine, Northeast Health Wangaratta, Wangaratta, VIC, Australia4Department of Endocrinology, Austin Health, Heidelberg, VIC, Australia5Department of Medicine, University of Melbourne, Parkville, VIC, Australia6Department of Renal Medicine, Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia
Abstract
Aim: To determine the association of admission pre-transplant haemoglobin A1c (HbA1c0) with post-transplant outcomes in kidney transplant recipients (KTRs), and post-transplant diabetes mellitus (PTDM) in those without pre-transplant diabetes.
Background: The utility of HbA1c0 in predicting post-transplant outcomes is unclear.
Methods: In this single-centre retrospective cohort study, 173 adult KTRs transplanted in 2012–2021 with a HbA1c0 and a minimum of 6-month follow-up were studied. Post-transplant outcomes were assessed using data linkage comprising the ANZDATA registry and electronic medical records. PTDM diagnosis was determined by the WHO 2019 criteria for type 2 diabetes and/or pharmacological treatment for hyperglycaemia at 12 months.
Results: Mean KTR age was 53±14 years, 63% identified as male and 24% had pre-transplant diabetes. Within 6 months, 5% of KTRs developed major adverse cardiovascular events (MACE). HbA1c0 was higher in those with MACE compared to those without (median 6.1% (interquartile range 6.0-6.3%) vs 5.3% (4.9-5.7%); P=0.0002). Of KTRs without pre-transplant diabetes (n=128), 18% developed PTDM at 12 months. HbA1c0 was higher in those who subsequently developed PTDM (5.5% (5.1-5.7%) vs 5.1% (4.8-5.4%); P=0.0074). Receiver operating characteristic analysis identified that HbA1c0 ≥5.95% helped predict MACE at 6 months (sensitivity 0.85, specificity 0.78), and ≥5.55% for de novo PTDM (sensitivity 0.89, specificity 0.69). Logistic regression identified HbA1c0 as a significant predictor at 12 months for de novo PTDM (OR 2.16 (95%CI 1.04-4.89)) and insulin requirement (OR 2.32 (95%CI 1.11-5.11)). HbA1c0 was not associated with the length of stay, ICU admission, graft function, rejection rate, graft or patient survival.
Conclusions: Pre-transplant HbA1c0 may serve as a prognostic indicator for post-transplant MACE and de novo PTDM, allowing identification of KTRs requiring more intensive monitoring post-transplant.
Biography
Dr Su Jen Chua is currently a second year nephrology advanced trainee at Alfred Health in Melbourne. As a member of the ANZDATA Haemodialysis Working Group and the ANZDATA Parenthood Working Group, she has an interest in the intersection between nephrology, epidemiology and obstetric medicine. Su Jen is a reviewer with the Cochrane Collaboration and has previously participated in systematic reviews for developing international guidelines in fertility.
Shaun Summers Clinical Trainee Award Presentation PDF Slides