@article {Hardinge001962, author = {Jessica L Harding and Meda Pavkov and Zhensheng Wang and Stephen Benoit and Nilka R{\'\i}os Burrows and Giuseppina Imperatore and Ann L Albright and Rachel Patzer}, title = {Long-term mortality among kidney transplant recipients with and without diabetes: a nationwide cohort study in the USA}, volume = {9}, number = {1}, elocation-id = {e001962}, year = {2021}, doi = {10.1136/bmjdrc-2020-001962}, publisher = {BMJ Specialist Journals}, abstract = {Introduction Little is known about the role diabetes (type 1 (T1D) and type 2 (T2D)) plays in modifying prognosis among kidney transplant recipients. Here, we compare mortality among transplant recipients with T1D, T2D and non-diabetes-related end-stage kidney disease (ESKD).Research design and methods We included 254 188 first-time single kidney transplant recipients aged >=18 years from the US Renal Data System (2000{\textendash}2018). Diabetes status, as primary cause of ESKD, was defined using International Classification of Disease 9th and 10th Clinical Modification codes. Multivariable-adjusted Cox regression models (right-censored) computed risk of death associated with T1D and T2D relative to non-diabetes. Trends in standardized mortality ratios (SMRs) (2000{\textendash}2017), relative to the general US population, were assessed using Joinpoint regression.Results A total of 72 175 (28.4\%) deaths occurred over a median survival time of 14.6 years. 5-year survival probabilities were 88\%, 85\% and 77\% for non-diabetes, T1D and T2D, respectively. In adjusted models, mortality was highest for T1D (HR=1.95, (95\% CI: 1.88 to 2.03)) and then T2D (1.65 (1.62 to 1.69)), as compared with non-diabetes. SMRs declined for non-diabetes, T1D, and T2D. However, in 2017, SMRs were 2.38 (2.31 to 2.45), 6.55 (6.07 to 7.06), and 3.82 (3.68 to 3.98), for non-diabetes, T1D and T2D, respectively.Conclusions In the USA, diabetes type is an important modifier in mortality risk among kidney transplant recipients with highest rates among people with T1D-related ESKD. Development of effective interventions that reduce excess mortality in transplant recipients with diabetes is needed, especially for T1D.Data are available in a public, open access repository. The USRDS database is freely available to the public. Therefore, studies conducted under the auspices of the USRDS are exempt from institutional review board approval.}, URL = {https://drc.bmj.com/content/9/1/e001962}, eprint = {https://drc.bmj.com/content/9/1/e001962.full.pdf}, journal = {BMJ Open Diabetes Research and Care} }