The relationship between diabetes and infectious hospitalizations in renal transplant recipients.
The implications of diabetes developing after kidney transplantation (PostTDM group) need further study. Worse graft survival is seen in PostTDM compared with nondiabetic (NonDM group) patients (1,2). Yet, there is paucity of data on the risk of infection, an issue that becomes even more important since posttransplant patients are already immunocompromised. Thus, we aim to compare the risk of infection in the posttransplant period in PostTDM patients and in patients who were diagnosed with diabetes before transplant (PreTDM group) with those without diabetes.

Data were obtained from the U.S. Renal Data System (3). The study population was limited to adult renal transplant patients whose primary payer was Medicare to enable analysis of hospital outcomes. Primary (i.e., first time) kidney transplant recipients from the years 1995 to 2000 were included. Pancreas recipients were excluded.

The diagnosis of diabetes was obtained from Medicare claims using a previously validated method and from U.S. Renal Data System transplant files (2,4). Patients were classified as PreTDM if diabetes was detected before, or at the time of, hospitalization for transplantation. The remaining diabetic patients were classified as PostTDM.

The outcome of interest was infection requiring hospitalization (HI) and occurring in the posttransplant period. The survival time until development of HI was analyzed using Cox multivariate proportional hazard …