Abstract：
OBJECTIVE: Post-transplant diabetes mellitus (PTDM) is a complex condition arising from various factors including immunosuppressive medications, insulin resistance, impaired insulin secretion, and inflammatory processes. Its impact on patient and graft survival is a significant concern in kidney transplant recipients. PTDM\'s impact on kidney transplant recipients, including patient and graft survival and cardiovascular mortality, is a significant concern, given conflicting findings in previous studies. This meta-analysis was imperative to not only incorporate emerging evidence but also to delve into cause-specific mortality considerations. We aimed to comprehensively evaluate the association between PTDM and clinical outcomes, including all-cause and cardiovascular mortality, sepsis-related mortality, malignancy-related mortality, and graft loss, in kidney transplant recipients.
METHODS: PubMed, Ovid/Medline, Web of Science, Scopus, and Cochrane Library databases were screened and studies evaluating the effect of PTDM on all-cause mortality, cardiovascular mortality, sepsis-related mortality, malignancy-related mortality, and overall graft loss in adult kidney transplant recipients were included.
RESULTS: 53 studies, encompassing a total of 138,917 patients, to evaluate the association between PTDM and clinical outcomes were included. Our analysis revealed a significant increase in all-cause mortality (RR 1.70, 95% CI 1.53 to 1.89, P<0.001) and cardiovascular mortality (RR 1.86, 95% CI 1.36 to 2.54, P<0.001) among individuals with PTDM. Moreover, PTDM was associated with a higher risk of sepsis-related mortality (RR 1.96, 95% CI 1.51 to 2.54, P<0.001) but showed no significant association with malignancy-related mortality (RR 1.20, 95% CI 0.76 to 1.88). Additionally, PTDM was linked to an increased risk of overall graft failure (RR 1.33, 95% CI 1.16 to 1.54, P<0.001).
CONCLUSIONS: These findings underscore the importance of comprehensive management strategies and the need for research targeting PTDM to improve outcomes in kidney transplant recipients.
METHODS: PubMed, Ovid/Medline, Web of Science, Scopus, and Cochrane Library databases were screened and studies evaluating the effect of PTDM on all-cause mortality, cardiovascular mortality, sepsis-related mortality, malignancy-related mortality, and overall graft loss in adult kidney transplant recipients were included.
RESULTS: 53 studies, encompassing a total of 138,917 patients, to evaluate the association between PTDM and clinical outcomes were included. Our analysis revealed a significant increase in all-cause mortality (RR 1.70, 95% CI 1.53 to 1.89, P<0.001) and cardiovascular mortality (RR 1.86, 95% CI 1.36 to 2.54, P<0.001) among individuals with PTDM. Moreover, PTDM was associated with a higher risk of sepsis-related mortality (RR 1.96, 95% CI 1.51 to 2.54, P<0.001) but showed no significant association with malignancy-related mortality (RR 1.20, 95% CI 0.76 to 1.88). Additionally, PTDM was linked to an increased risk of overall graft failure (RR 1.33, 95% CI 1.16 to 1.54, P<0.001).
CONCLUSIONS: These findings underscore the importance of comprehensive management strategies and the need for research targeting PTDM to improve outcomes in kidney transplant recipients.
摘要：
目的：移植后糖尿病（PTDM）是由多种因素引起的复杂疾病，包括免疫抑制药物，胰岛素抵抗，胰岛素分泌受损，和炎症过程。它对患者和移植物存活的影响是肾移植受者的重要关注点。PTDM对肾移植受者的影响，包括患者和移植物存活率和心血管死亡率，是一个重要的问题，鉴于先前研究中相互矛盾的发现。这种荟萃分析不仅必须纳入新出现的证据，而且必须深入研究特定原因的死亡率。我们旨在全面评估PTDM与临床结局之间的关系，包括全因死亡率和心血管死亡率,脓毒症相关死亡率，恶性肿瘤相关死亡率，和移植物丢失，肾移植受者。
方法：PubMed，Ovid/Medline,WebofScience,Scopus,和Cochrane图书馆数据库被筛选和研究评估PTDM对全因死亡率的影响，心血管死亡率，脓毒症相关死亡率，恶性肿瘤相关死亡率，并纳入了成人肾移植受者的总体移植物丢失。
结果：53项研究，涵盖总共138,917名患者，评估PTDM与临床结局之间的相关性.我们的分析显示，PTDM患者的全因死亡率（RR1.70，95%CI1.53至1.89，P<0.001）和心血管死亡率（RR1.86，95%CI1.36至2.54，P<0.001）显著增加。此外，PTDM与脓毒症相关死亡率风险较高相关(RR1.96,95%CI1.51~2.54,P<0.001),但与恶性肿瘤相关死亡率无显著相关性(RR1.20,95%CI0.76~1.88)。此外,PTDM与总体移植物衰竭风险增加相关(RR1.33,95%CI1.16~1.54,P<0.001)。
结论：这些发现强调了全面管理策略的重要性，以及针对PTDM的研究需要改善肾移植受者的预后。
方法：PubMed，Ovid/Medline,WebofScience,Scopus,和Cochrane图书馆数据库被筛选和研究评估PTDM对全因死亡率的影响，心血管死亡率，脓毒症相关死亡率，恶性肿瘤相关死亡率，并纳入了成人肾移植受者的总体移植物丢失。
结果：53项研究，涵盖总共138,917名患者，评估PTDM与临床结局之间的相关性.我们的分析显示，PTDM患者的全因死亡率（RR1.70，95%CI1.53至1.89，P<0.001）和心血管死亡率（RR1.86，95%CI1.36至2.54，P<0.001）显著增加。此外，PTDM与脓毒症相关死亡率风险较高相关(RR1.96,95%CI1.51~2.54,P<0.001),但与恶性肿瘤相关死亡率无显著相关性(RR1.20,95%CI0.76~1.88)。此外,PTDM与总体移植物衰竭风险增加相关(RR1.33,95%CI1.16~1.54,P<0.001)。
结论：这些发现强调了全面管理策略的重要性，以及针对PTDM的研究需要改善肾移植受者的预后。
