A new study in Nephrology Dialysis Transplantation has examined the relationship between metabolic disorder (MetS) and adverse outcomes in recipients of kidney transplants. The national prospective cohort study was designed by a team led by Yu Ho Lee (Cha University, Seongnam, South Korea) and which featured corresponding author Hyeon Seok Hwang (Kyung Lee University Medical Center, Seoul, South Korea).
This work follows a 2019 study in Transplantation which also probed the condition in kidney transplant patients. First author Winnie Chan (Queen Elizabeth Hospital, Birmingham, UK) and others suggested in the conclusion of that report that dietary interventions, including a cut to fructose intake and a systemic endotoxemia, were “plausible targets” for improving this population’s metabolic health, but they did not investigate the graft loss risk associated with MetS.
Lee and colleagues’ study looked at data from a total of 4,187 kidney transplant recipients registered in a Korean database during the period 2014–2020. MetS was designated as the presence of at least three components of the syndrome, while patients were categorised into four groups according to their pre- and post-transplant MetS status: MetS-free, MetS-developed, MetS-recovered, and MetS-persistent. The primary outcomes analysed were death-censored graft loss and a composite of cardiovascular events and death.
Among recipients without pre-transplant MetS, it was found that 19.6% (419 of 2,135) developed MetS after transplantation. Those with pre-transplant MetS, 38.7% (794 of 2,052) no longer had the condition following transplantation. Among the four groups, the MetS-developed group exhibited the worst graft survival rate, while the MetS-persistent group had a poorer composite event-free survival rate.
Compared to the MetS-free group, the MetS development was associated with a significantly higher risk of graft loss (adjusted hazard ratio [aHR], 2.35; 95% confidence interval [CI], 1.17–4.98). This risk “increased with the number of dysfunctional MetS components”, the authors note, while the MetS-persistent group faced increased risks of cardiovascular events and death (aHR, 2.46; 95% CI, 1.12-5.63). Changes in the number of dysfunctional MetS components did not affect this risk, however.
Lee et al argue in their conclusion that “kidney transplantation significantly alters the metabolic status” of patients. Post-transplantation development of MetS was associated with higher graft loss risk, while “persistent MetS exposure before and after transplantation increased the likelihood of cardiovascular events and negatively impacted patient survival”.
