Clinical implications of changes in metabolic syndrome status after kidney transplantation: a nationwide prospective cohort study

Author:

Lee Yu Ho1,Song Sang Heon2,Song Seung Hwan3,Shin Ho Sik4,Yang Jaeseok5ORCID,Kim Myoung Soo6,Hwang Hyeon Seok7,Ahn Curie,Yang Jaeseok,Kong Jin Min,Kwon Oh Jung,Kim Deok Gie,Jung Cheol-Woong,Kim Yeong Hoon,Kim Joong Kyung,Kim Chan-Duck,Min Ji Won,Park Sung Kwang,Park Yeon Ho,Berm Park Jae,Park Jung Hwan,Park Jong-Won,Ban Tae Hyun,Song Sang Heon,Song Seung Hwan,Shin Ho Sik,Yang Chul Woo,Yoon Hye Eun,Lee Kang Wook,Lee Dong Ryeol,Lee Dong Won,Lee Sam Yeol,Lee Sang-Ho,Lee Su Hyung,Lee Jung Jun,Lee Jung Pyo,Lee Jeong-Hoon,Jeon Jin Seok,Jun Heungman,Jeong Kyung Hwan,Chung Ku Yong,Cho Hong Rae,Ki Ju Man,Chae Dong-Wan,Choi Soo Jin Na,Han Duck Jong,Han Seungyeup,Ha Kyu,

Affiliation:

1. Division of Nephrology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University , Seongnam , Korea

2. Department of Internal Medicine, Pusan National University Hospital , Pusan , Korea

3. Department of Surgery, Ewha Womans University Seoul Hospital , Seoul , Korea

4. Division of Nephrology, Department of Internal Medicine, Kosin University College of Medicine , Pusan , Korea

5. Division of Nephrology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital , Seoul , Korea

6. Department of Surgery, Yonsei University College of Medicine , Seoul , Korea

7. Division of Nephrology, Department of Internal Medicine, Kyung Hee University School of Medicine, Kyung Hee University Medical Center , Seoul , Korea

Abstract

ABSTRACT Background Metabolic syndrome (MetS) is prevalent in patients with end-stage kidney disease, and kidney transplantation is expected to modify the metabolic status. However, whether changes in metabolic status at the time of transplantation affect recipient outcomes remains unclear. Methods We analyzed 4187 recipients registered in a nationwide prospective cohort from 2014 to 2020. MetS was defined as the presence of three or more components of the metabolic syndrome. Patients were classified based on the pre- and post-transplant MetS status: MetS-free, MetS-developed, MetS-recovered and MetS-persistent. Study outcomes were occurrence of death-censored graft loss and a composite of cardiovascular events and death. Results Among recipients without pre-transplant MetS, 19.6% (419/2135) developed post-transplant MetS, and MetS disappeared in 38.7% (794/2052) of the recipients with pre-transplant MetS. Among the four groups, the MetS-developed group showed the worst graft survival rate, and the MetS-persistent group had a poorer composite event-free survival rate. Compared with the MetS-free group, the MetS-developed group was associated with an increased risk of graft loss [adjusted hazard ratio (aHR) 2.35; 95% confidence interval (CI) 1.17–4.98] and the risk of graft loss increased with increasing numbers of dysfunctional MetS components. MetS-persistent was associated with increased risks of cardiovascular events and death (aHR 2.46; 95% CI 1.12–5.63), but changes in the number of dysfunctional MetS components was not. Conclusion Kidney transplantation significantly alters the metabolic status. Newly developed MetS after transplantation was associated with an increased risk of graft loss, whereas persistent MetS exposure before and after transplantation was associated with increased risks cardiovascular events and patient survival.

Funder

Research of Korea Centers for Disease Control and Prevention Agency

National Research Foundation of Korea

Publisher

Oxford University Press (OUP)

Subject

Transplantation,Nephrology

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