ORIGINAL RESEARCH
Transpl. Int.
Impact of Early Post-Transplantation Diabetes Mellitus and Changes in Diabetic Status on Graft Failure and Mortality in Kidney Transplant Recipients
- JJ
Junseok Jeon 1
- HR
Hye Ryoun Jang 1
- YP
Yebin Park 2
- KL
Kyungho Lee 1
- JE
Jung Eun Lee 1
- KH
Kyungdo Han 3
- WH
Wooseong Huh 1
1. Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
2. Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
3. Soonsil University, Seoul, Republic of Korea
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Abstract
Post-transplantation diabetes mellitus (PTDM) is a common complication following kidney transplantation (KT), but the prognostic significance of early PTDM and changes in diabetic status remains uncertain. Using the Korean National Health Insurance Service database, we analyzed 8,486 KT recipients (KTRs) who underwent national health screening from 2009 to 2017. Early PTDM was defined as new-onset diabetes between 3 months and 1 year after KT. Cox regression estimated the risk of graft failure and all-cause mortality. Early PTDM and preexisting DM were present in 12.2% and 28.5% of KTRs, respectively. Early PTDM was significantly associated with mortality (aHR 1.309, 95% CI 1.015–1.689), but not with graft failure. Changes in diabetic status were not significantly associated with graft failure. However, transition from non-DM to PTDM (aHR 1.646, 95% CI 1.080–2.510) and persistent early PTDM (aHR 1.755, 95% CI 1.325–2.377) were associated with increased mortality, whereas regression from early PTDM to non-DM was not. Preexisting DM was associated with increased mortality regardless of subsequent changes, with relatively lower risk in those who regressed to non-DM. Changes in diabetic status have a greater impact on outcomes than early PTDM, highlighting the importance of continuous glycemic monitoring and individualized care in KTRs.
Summary
Keywords
all-cause mortality, diabetic status, early post-transplant diabetes mellitus, graft failure, kidney transplantation
Received
23 August 2025
Accepted
13 April 2026
Copyright
© 2026 Jeon, Jang, Park, Lee, Lee, Han and Huh. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Wooseong Huh, wooseong.huh@samsung.com
Disclaimer
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