Year: 2003
Type: article
Abstract: To the Editor: We agree entirely with the comments of Dr Schnitzler, and reiterate that these results do not prove cause and effect. Certainly, the results in Table 3 of our manuscript do not prove that post-transplant diabetes mellitus (PTDM) causes graft failure, death-censored graft failure, or death (1Kasiske BL Snyder JJ Gilbertson D Matas AJ Diabetes mellitus after kidney transplantation in the United States.Am J Transplant. 2003; 3: 178-185Abstract Full Text Full Text PDF PubMed Scopus (1058) Google Scholar). It is quite possible that PTDM is associated with worse outcomes because it is also associated with some other unmeasured factor(s) that cause both PTDM and worse outcomes. Acute rejection and its treatment with corticosteroids, for example, could cause both PTDM and worse outcomes. The purpose of this analysis was to determine whether the association between PTDM and graft failure was statistically independent of all the characteristics that were themselves associated with PTDM. We were not trying to determine whether tacrolimus was an independent predictor of outcomes. In fact, we believe that attempting to infer causal relationships between immunosuppressive agents and outcomes using registry data is particularly hazardous, as the choice of immunosuppressive agents is often made to mitigate risks, and after transplantation these agents are often changed as risk changes. Nevertheless, we believe that the relationship between tacrolimus and lower graft failure rates was not greatly mitigated by the association between tacrolimus and PTDM, which in turn was associated with a higher risk for graft failure. Indeed, the relative risk for graft failure associated with tacrolimus, adjusting for the effects of PTDM, was 0.70 (95% confidence interval 0.59–0.83, p < 0.0001), which was virtually identical to the relative risk of tacrolimus alone [not adjusting for PTDM, 0.72 (0.61–0.86, p < 0.0002)]. This was also true for both death-censored graft failure and death (data not shown). The other covariates in Table 3 that showed an association with PTDM also remained relatively unchanged when removing PTDM from the analysis (data not shown). Aside from all of these considerations and caveats, we believe that the data support our conclusions that (1Kasiske BL Snyder JJ Gilbertson D Matas AJ Diabetes mellitus after kidney transplantation in the United States.Am J Transplant. 2003; 3: 178-185Abstract Full Text Full Text PDF PubMed Scopus (1058) Google Scholar) there is a high incidence of PTDM after kidney transplantation, (2) several patient characteristics (and type of immunosuppressive agents used initially) are associated with PTDM, and (3) PTDM is associated with poor outcomes. Further studies are certainly warranted.
Institutions: Hennepin County Medical Center, University of Minnesota
Language: English
Subfield: Transplantation
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,300
OpenAlex ID: W4249266297